Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018
L Evered, B Silbert, D S Knopman, D A Scott, S T DeKosky, L S Rasmussen, E S Oh, G Crosby, M Berger, R G Eckenhoff, Nomenclature Consensus Working Group, Lisbeth Evered, Roderic G Eckenhoff, David Ames, Alex Bekker, Miles Berger, Deborah Blacker, Jeffrey Browndyke, Greg Crosby, Stacie G Deiner, Diederik van Dijk, Steven T DeKosky, Maryellen F Eckenhoff, Lars Eriksson, Dougas Galasko, Kirk Hogan, Sharon Inouye, David Knopman, Constantine Lyketsos, Edward Marcantonio, Paul Maruff, Mervyn Maze, Esther Oh, Beverley A Orser, Thomas Ottens, Catherine Price, Lars S Rasmussen, Perminder Sachdev, Katie Schenning, David A Scott, Frederick E Seiber, Brendan Silbert, Jeff Silverstein, Jacob Steinmetz, Niccolo Terrando, Paula Trzapacz, Rob Whittington, Zhongcong Xie, L Evered, B Silbert, D S Knopman, D A Scott, S T DeKosky, L S Rasmussen, E S Oh, G Crosby, M Berger, R G Eckenhoff, Nomenclature Consensus Working Group, Lisbeth Evered, Roderic G Eckenhoff, David Ames, Alex Bekker, Miles Berger, Deborah Blacker, Jeffrey Browndyke, Greg Crosby, Stacie G Deiner, Diederik van Dijk, Steven T DeKosky, Maryellen F Eckenhoff, Lars Eriksson, Dougas Galasko, Kirk Hogan, Sharon Inouye, David Knopman, Constantine Lyketsos, Edward Marcantonio, Paul Maruff, Mervyn Maze, Esther Oh, Beverley A Orser, Thomas Ottens, Catherine Price, Lars S Rasmussen, Perminder Sachdev, Katie Schenning, David A Scott, Frederick E Seiber, Brendan Silbert, Jeff Silverstein, Jacob Steinmetz, Niccolo Terrando, Paula Trzapacz, Rob Whittington, Zhongcong Xie
Abstract
Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face-to-face meetings followed by online editing of draft versions. Two major classification guidelines [Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) and National Institute for Aging and the Alzheimer Association (NIA-AA)] are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that 'perioperative neurocognitive disorders' be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).
Keywords: cognition disorders; delirium; neurocognitive disorders; postoperative complications.
Conflict of interest statement
The authors L.E., R.G.E., D.S.K., D.A.S., B.S., E.S.O., D.A., A.B., D.B., S.G.D., D.v.D., M.F.E., D.G., K.H., S.I., E.M., P.M., B.A.O., T.O., C.P., P.S., K.S., F.E.S., J.S., N.T., P.T., R.W., and Z.X. declare that they have no conflicts of interest.
M.B.: unrelated funding from Minnetronix Inc.; material support from Masimo; Associate Editor Journal of Alzheimer's Disease; participated in activities of the ASA BHI.
G.C.: Editor of Anesthesia & Analgesia; Editor of Journal of Clinical Anesthesia.
S.T.D.K.: previously consulted for Roche, Novartis, Biogen, Acumen, Cognition Therapeutics, Amgen.
L.S.R.: editorial board member Acta Anaesthesiologica Scandinavica; wife received research funding and lecture fees from Merck.
L. E.: shareholder of Alphasyx Inc.
J.B.: payments and travel funding for consultancy from Claret Medical Inc.
M.M.: cofounded NeuroproteXeon, received founders' stock and stock options; previously consulted for Masimo.
C.L.: grant support from Forest, Glaxo-Smith-Kline, Eisai, Pfizer, Astra-Zenica, Lilly, Ortho-McNeil, Bristol-Myers, Novartis, NFL Benefits Office, Elan, Functional Neuromodulation. Consultant/Advisor for: Astra-Zenica, Glaxo-Smith-Kline, Eisai, Novartis, Forest, Supernus, Adlyfe, Takeda, Wyeth, Lundbeck, Merz, Lilly, Pfizer, Genentach, Elan, NFL Players Association, NFL Benefits Office, Avamir, Zinfandel, BMS, Abvie, Janssen, Orion, Otsuka, Astellas.
Copyright © 2018 Jointly by the British Journal of Anaesthesia, American Society of Anesthesiologists Inc, Wolters Kluwer Health Inc, International Anesthestic Research Society, Canadian Anesthesiologist’s Society, Acta Anaesthesiologica Scandinavica Foundation, and IOS Press., Jointly by the British Journal of Anaesthesia, American Society of Anesthesiologists Inc, International Anesthesia Research Society, Canadian Anesthesiologist’s Society, Acta Anaesthesiologica Scandinavica Foundation, and IOS Press. Published by Elsevier Ltd.. All rights reserved.
Source: PubMed