State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

Abstract

Cognitive recovery after anaesthesia and surgery is a concern for older adults, their families, and caregivers. Reports of patients who were 'never the same' prompted a scientific inquiry into the nature of what patients have experienced. In June 2018, the ASA Brain Health Initiative held a summit to discuss the state of the science on perioperative cognition, and to create an implementation plan for patients and providers leveraging the current evidence. This group included representatives from the AARP (formerly the American Association of Retired Persons), American College of Surgeons, American Heart Association, and Alzheimer's Association Perioperative Cognition and Delirium Professional Interest Area. This paper summarises the state of the relevant clinical science, including risk factors, identification and diagnosis, prognosis, disparities, outcomes, and treatment of perioperative neurocognitive disorders. Finally, we discuss gaps in current knowledge with suggestions for future directions and opportunities for clinical and translational projects.

Keywords: anaesthesia; delirium; geriatrics; neurocognitive disorders; perioperative brain health; postoperative cognitive dysfunction; postoperative complications.

Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

Figures

Fig 1

Postoperative cognitive dysfunction and neurocognitive disorders, a crosswalk. MCI, mild cognitive impairment; POCD, postoperative cognitive dysfunction.* Where a new diagnosis is made after 12 months.

Fig 2

Perioperative acceleration of neuropathology. HPA, hypothalamic–pituitary–adrenal.