Unveiling the Risk Factors for Postoperative Cognitive Dysfunction
Main Article Content
Abstract
Postoperative cognitive decline (POCD), a concerning consequence of surgery, can significantly impact a patient's recovery and long-term well-being. This study gives insights into a multifaceted exploration of risk factors associated with POCD. It meticulously examines pre-operative patient characteristics such as age, educational background, and the presence of pre-existing cognitive decline. Intra-operative factors under investigation include the complexity and duration of the surgery, and the specific anesthetic agents employed. The study aims to shed light on the mechanisms underlying POCD. This comprehensive analysis has the potential to empower healthcare professionals in developing more targeted preventative measures. By identifying high-risk patients, clinicians can implement pre-operative interventions like cognitive training or medication adjustments. Additionally, optimizing surgical protocols to minimize blood flow disruptions and selecting the most neuroprotective anesthetic agents could further mitigate POCD risk.
Downloads
Article Details
References
Hu R, Huang D, Tong J, Liao Q, Hu Z, Ouyang W. Aspartic acid in the hippocampus: a biomarker for postoperative cognitive dysfunction. Neural Regeneration Research. 2014;9(2):143. doi:10.4103/1673-5374.125343
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington: 2013;American psychiatric association. Available from : https://repository.poltekkes-kaltim.ac.id/657/1/Diagnostic%20and%20statistical%20manual%20of%20mental%20disorders%20_%20DSM-5%20(%20PDFDrive.com%20).pdf
Steinmetz J, Rasmussen L. Peri‐operative cognitive dysfunction and protection. Anaesthesia. 2015;71(S1):58-63. doi:10.1111/anae.13308
Peng X, Liu R, Zhu Y, Xu Q, Li J. Sevoflurane versus isoflurane for postoperative cognitive dysfunction of patients undergoing major cardiac surgeries: a prospective cohort study. Indian Journal of Pharmaceutical Education and Research. 2019;53(4):710-715. doi:10.5530/ijper.53.4.135
Strøm C, Rasmussen L, Sieber F. Should general anaesthesia be avoided in the elderly?. Anaesthesia. 2013;69(s1):35-44. doi: 10.1111/anae.12493
Schenning K, Murchison C, Mattek N, Kaye J, Quinn J. Sex and genetic differences in postoperative cognitive dysfunction: a longitudinal cohort analysis. Biology of Sex Differences. 2019;10(1). doi:10.1186/s13293-019-0228-8.
Daiello LA, Racine AM, Gou YR, Marcantiono ER, Xie Z, Kunze LJ, et al. Postoperative delirium and postoperative cognitive dysfunction. Anesthesiology. 2019;131(3):477-491. doi:10.1097/aln.0000000000002729
Takazawa T, Horiuchi T, Orihara M, Nagumo K, Tomioka A, Ideno Y, et al. Prevention of postoperative cognitive dysfunction by minocycline in elderly patients after total knee arthroplasty: a randomized, double-blind, placebo-controlled clinical trial. Anesthesiology. 2022;138(2):172-183. doi:10.1097/aln.0000000000004439
Jildenstål P, Rawal N, Hallén J, Berggren L, Jakobsson J. Perioperative management in order to minimise postoperative delirium and postoperative cognitive dysfunction: results from a swedish web-based survey. Annals of Medicine and Surgery. 2014;3(3):100-107. doi:10.1016/j.amsu.2014.07.001
Li L, Luo Y, Liu M, Xue H. Clinical characteristics of postoperative cognitive dysfunction after local balloon compression for trigeminal neuralgia: a retrospective study. Research square. 2023;1. doi:10.21203/rs.3.rs-2649508/v1
Subramaniyan S, Terrando N. Neuroinflammation and perioperative neurocognitive disorders. Anesthesia & Analgesia. 2019;128(4):781-788. doi:10.1213/ane.0000000000004053.
Degos V, Vacas S, Han Z, Rooijen N, Gressèns P, Su H, et al. Depletion of bone marrow–derived macrophages perturbs the innate immune response to surgery and reduces postoperative memory dysfunction. Anesthesiology. 2013;118(3):527-536. doi:10.1097/aln.0b013e3182834d94.
Terrando N, Eriksson L, Ryu J, Yang T, Monaco C, Feldmann M, et al. Resolving postoperative neuroinflammation and cognitive decline. Annals of Neurology. 2011;70(6):986-995. doi:10.1002/ana.226647.
Duan S, Wang X, Chen G, Quan C, Qu S, Tong J. Inhibiting ripk1 limits neuroinflammation and alleviates postoperative cognitive impairments in d-galactose-induced aged mice. Frontiers in Behavioral Neuroscience. 2018;12. doi:10.3389/fnbeh.2018.00138.
Wan Y, Xu J, Meng F, Bao Y, Ge Y, Lobo N, et al. Cognitive decline following major surgery is associated with gliosis, β-amyloid accumulation, and τ phosphorylation in old mice. Critical Care Medicine. 2010;38(11): 2190-2198. doi:10.1097/CCM.0b013e3181f17bcb.
Kho W, Haefen C, Paeschke N, Nasser F, Endesfelder S, Sifringer M, et al. Dexmedetomidine restores autophagic flux, modulates associated micrornas and the cholinergic anti-inflammatory pathway upon lps-treatment in rats. Journal of Neuroimmune Pharmacology. 2021;17(1-2):261-276. doi:10.1007/s11481-021-10003-w9.
Nair AS, Christopher A, Pulipaka SK, Suvvari P, Kodisharapu PK, Rayani BK. Efficacy of xenon anesthesia in preventing postoperative cognitive dysfunction after cardiac and major non-cardiac surgeries in elderly patients: a topical review. Medical Gas Research. 2021;11(3):110. doi:10.4103/2045-9912.3143302.
Berger M, Terrando N, Smith S, Browndyke J, Newman M, Mathew J. Neurocognitive function after cardiac surgery. Anesthesiology. 2018;129(4):829-851. doi:10.1097/aln.0000000000002194
Kapoor MC. Neurological dysfunction after cardiac surgery and cardiac intensive care admission: a narrative review part 1: the problem; nomenclature; delirium and postoperative neurocognitive disorder; and the role of cardiac surgery and anesthesia. Annals of Cardiac Anaesthesia. 2020;23(4):383. doi:10.4103/aca.aca_138_19
Okonkwo OC, Cohen RA, Gunstad J, Tremont G, Alosco ML, Poppas A. Longitudinal trajectories of cognitive decline among older adults with cardiovascular disease. Cerebrovascular Diseases. 2010;30(4):362-373. doi:10.1159/000319564
Monk TG, Weldon BC, Garvan CW, Dede DE, Aa MT, Heilman KM, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108(1):18-30. doi:10.1097/01.anes.0000296071.19434.1e
Rudolph JL, Marcantonio ER, Culley DJ, Silverstein JH, Rasmussen LS, Crosby GJ, et al. Delirium is associated with early postoperative cognitive dysfunction. Anaesthesia. 2008;63(9):941-947. doi:10.1111/j.1365-2044.2008.05523.x
Klinger RY, James OG, Wong TZ, Newman MF, Doraiswamy PM, Mathew JP. Cortical β-amyloid levels and neurocognitive performance after cardiac surgery. BMJ Open. 2013;3(9):e003669. doi:10.1136/bmjopen-2013-003669
Hudetz JA, Patterson KM, Byrne AJ, Iqbal Z, Gandhi SD, Warltier DC, et al. A history of alcohol dependence increases the incidence and severity of postoperative cognitive dysfunction in cardiac surgical patients. International Journal of Environmental Research and Public Health. 2009;6(11):2725-2739. doi:0.3390/ijerph6112725
Robinson TN, Wu DS, Pointer LF, Dunn CL, Moss M. Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly. Journal of the American College of Surgeons. 2012;215(1):12-17. doi:10.1016/j.jamcollsurg.2012.02.007
Culley DJ, Flaherty D, Fahey MC, Rudolph JL, Javedan H, Huang CC, et al. Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients. Anesthesiology. 2017;127(5):765-774. doi:10.1097/aln.0000000000001859
Au E, Thangathurai G, Saripella A, Yan E, Englesakis M, Nagappa M, et al. Postoperative outcomes in elderly patients undergoing cardiac surgery with preoperative cognitive impairment: a systematic review and meta-analysis. Anesthesia & Analgesia. 2023;136(6):1016-1028. doi:10.1213/ane.0000000000006346
Weiss Y, Zac L, Refaeli E, Ben-Yishai S, Zegerman A, Cohen B, et al. Preoperative cognitive impairment and postoperative delirium in elderly surgical patients. Annals of Surgery. 2022;278(1):59-64. doi:10.1097/sla.0000000000005657
Susano MJ, Grasfield RH, Friese M, Rosner B, Crosby G, Bader AM, et al. Brief preoperative screening for frailty and cognitive impairment predicts delirium after spine surgery. Anesthesiology. 2020;133(6):1184-1191. doi:10.1097/aln.0000000000003523
O' Brien H, Mohan H, Hare CO, Reynolds JV, Kenny RA. Mind over matter? the hidden epidemic of cognitive dysfunction in the older surgical patient. Annals of Surgery. 2017;265(4):677-691. doi:10.1097/sla.0000000000001900
Zietlow K, McDonald S, Sloane R, Browndyke J, Lagoo-Deenadayalan S, Heflin M. Preoperative cognitive impairment as a predictor of postoperative outcomes in a collaborative care model. Journal of the American Geriatrics Society. 2018;66(3):584-589. doi:10.1111/jgs.15261
Holmgaard F, Vedel AG, Rasmussen LS, Paulson OB, Nilsson JC, Ravn HB. The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: a secondary analysis of a randomised trial. Br J Anaesth. 2019;123(2):196-205. doi: 10.1016/j.bja.2019.03.045.
van Harten AE, Scheeren TW, Absalom AR. A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia. Anaesthesia, 2012;67 doi:10.1111/j.1365-2044.2011.07008.x.
Devore EE, Fong TG, Marcantonio ER, Schmitt EM, Travison TG, Jones RN, et al. Prediction of Long-term Cognitive Decline Following Postoperative Delirium in Older Adults. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences. 2017: 1697–1702. doi:10.1093/gerona/glx030.
Tzimas P, Samara E, Petrou A, Korompilias A, Chalkias A, Papadopoulos G. The influence of anesthetic techniques on postoperative cognitive function in elderly patients undergoing hip fracture surgery: General vs spinal anesthesia. Injury. 2018;49(12):2221–6. DOI: 10.1016/j.injury.2018.09.023
Vacas S, Cole DJ, Cannesson M. Cognitive decline associated with anesthesia and surgery in older patients. JAMA. 2021;326(9):863. doi:10.1001/jama.2021.47732.
Weerink LBM, van Leeuwen BL, Gernaat SAM, Absalom AR, Huisman MG, van der Wal-Huisman H, et al. Vitamin status and the development of postoperative cognitive decline in elderly surgical oncologic patients. Annals of Surgical Oncology. 2017;25(1):231-238. doi:10.1245/s10434-017-6118-63.
Norkienė I, Samalavičius R, Misiūrienė I, Paulauskienė K, Budrys V, Ivaškevičius J. Incidence and risk factors for early postoperative cognitive decline after coronary artery bypass grafting. Medicina. 2010;46(7):460. doi:10.3390/medicina460700664.
Požgain Z, Dulić G, Kondža G, Bogović S, Šerić I, Hil D, et al. Is postoperative cognitive decline after cardiac surgery associated with plasma beta amyloid 1–42 levels?. Journal of Cardiothoracic Surgery. 2022;17(1). doi:10.1186/s13019-022-01755-45.
Anderson K, Ziegler O, Shi G, Sodha N, Ikeda I, Feng J, et al. Younger age is associated with greater early neurocognitive decline postcardiopulmonary bypass. JTCVS Open. 2020;1:1-9. doi:10.1016/j.xjon.2020.02.0016.
Griffiths R, Beech F, Brown A, Dhesi J, Foo I, Goodall J, et al. Peri‐operative care of the elderly 2014. Anaesthesia. 2013;69(s1):81-98. doi:10.1111/anae.12524
Ishizawa Y. Does preoperative cognitive optimization improve postoperative outcomes in the elderly?. Journal of Clinical Medicine. 2022;11(2):445. doi:10.3390/jcm11020445
Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Montanini S, et al. Monitoring cerebral oxygen saturation in elderly patients undergoing general abdominal surgery: a prospective cohort study. European Journal of Anaesthesiology. 2006;24(01):59. doi:10.1017/s0265021506001025
Oldham MA, Vachon J, Yuh D, Lee HB. Cognitive outcomes after heart valve surgery: a systematic review and meta‐analysis. Journal of the American Geriatrics Society. 2018;66(12):2327-2334. doi:10.1111/jgs.15601
Kotekar N, Kuruvilla CS, Murthy V. Postoperative cognitive dysfunction in the elderly: a prospective clinical study. Indian J Anaesth. 2014; 58: 263–8. DOI: 10.4103/0019-5049.135034
Bilel S, Giorgetti A, Tirri M, Arfè R, Cristofori V, Marchetti B, et al. Sensorimotor alterations induced by novel fentanyl analogs in mice: possible impact on human driving performances. Current Neuropharmacology. 2023;21(1):87-104. doi:10.2174/1570159x21666221116160032
Saczynski JS, Marcantonio ER, Quach L, Fong TG, Gross A, Inouye SK, et al. Cognitive trajectories after postoperative delirium. Survey of Anesthesiology. 2012;56(6):286-287. doi:10.1097/01.sa.0000422670.97733.97
Rachman A, Sauriasari R, Syafhan N, Prawiroharjo P, Risni H. Cognitive function in type 2 diabetes mellitus patients taking metformin and metformin-sulfonylurea. Kesmas National Public Health Journal. 2022;17(4):270. doi:10.21109/kesmas.v17i4.6303
Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, et al. Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. The Lancet. 1998 Mar;351(9106):857–61. doi:10.1016/S0140-6736(97)07382-0.
Feinkohl I, Winterer G, Spies CD, Pischon T. Cognitive Reserve and the Risk of Postoperative Cognitive Dysfunction. Deutsches Arzteblatt international. 2017: 110-117 . doi:10.3238/arztebl.2017.0110.
O'Brien K, Feng R, Sieber F, Marcantonio ER, Tierney A, Magaziner J, et al. Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: secondary analysis of a randomized clinical trial. Alzheimer S & Dementia. 2023;19(9):4008-4019. doi:10.1002/alz.13132
Kundu M, Abdulla E, Rahman MM. Letter: spine surgery under spinal vs general anesthesia: prospective analysis of quality of life, fatigue, and cognition. Neurosurgery. 2022;92(1):e9-e9. doi:10.1227/neu.0000000000002217
Liu Y, Su M, Li W, Yuan H, Yang C. Comparison of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway and nerve block for intertrochanteric fracture surgeries in elderly patients: a retrospective cohort study. BMC Anesthesiology. 2019;19(1). doi:10.1186/s12871-019-0908-2
Efstathiou G, Batistaki C, Soulioti E, Roungeris L, Matsota P. Opioid-free anesthesia and postoperative cognitive dysfunction after minor urological surgery: a case series study. Anesthesiology and Pain Medicine. 2022;12(1). doi:10.5812/aapm.122094
Jeenger L, Jeenger J, Dulara SC, Joshi A. A comparative study of postoperative cognitive dysfunction in elderly patients undergoing hip surgery after general anaesthesia and combined spinal and epidural anaesthesia. Indian Journal of Clinical Anaesthesia. 2016: 362-367. doi:10.5958/2394-4994.2016.00063.9.
Duan GY, Duan ZX, Chen H, Chen F, Chen F, Du ZY, et al. Cognitive function and delirium following sevoflurane or propofol anesthesia for valve replacement surgery: a multicenter randomized controlled trial. The Kaohsiung Journal of Medical Sciences. 2022;39(2):166-174. doi:10.1002/kjm2.12618
Schoen J, Husemann L, Tiemeyer C, Lueloh A, Sedemund-Adib B, Berger KU, et al. Cognitive function after sevoflurane- vs propofol-based anaesthesia for on-pump cardiac surgery: a randomized controlled trial. British journal of anaesthesia. 2011: 840-50. doi:10.1093/bja/aer091.
Liu Y, Ma L, Jiao L, Gao M, Guo W, Chen L, et al. Mammalian target of rapamycin/p70 ribosomal s6 protein kinase signaling is altered by sevoflurane and/or surgery in aged rats. Molecular Medicine Reports. 2012;12(6):8253-8260. doi:10.3892/mmr.2015.4444
Ye JS, Chen L, Lu YY, Lei SQ, Peng M, Xia ZY. Honokiol-mediated mitophagy ameliorates postoperative cognitive impairment induced by surgery/sevoflurane via inhibiting the activation of nlrp3 inflammasome in the hippocampus. Oxidative Medicine and Cellular Longevity. 2019:1-13. doi:10.1155/2019/8639618
Xu X, Tian X, Wang G. Sevoflurane reduced functional connectivity of excitatory neurons in prefrontal cortex during working memory performance of aged rats. Biomedicine & pharmacotherapy. 2018:106;1258-1266. doi:10.1016/j.biopha.2018.07.043.
Gong Z, Li J, Zhong Y, Guan X, Huang A, Ma L. Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting. Experimental and Therapeutic Medicine. 2018. doi:10.3892/etm.2018.6778
Bi X, Wei J, Zhang X. Effects of dexmedetomidine on neurocognitive disturbance after elective non-cardiac surgery in senile patients: a systematic review and meta-analysis. Journal of International Medical Research. 2021;49(5):030006052110142. doi:10.1177/03000605211014294
Feng M, Chen X, Liu T, Zhang C, Wan L, Yao W. Dexmedetomidine and sufentanil combination versus sufentanil alone for postoperative intravenous patient-controlled analgesia: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiology. 2019;19(1). doi:10.1186/s12871-019-0756-0
Chen N, Chen X, Xie J, Wu C, Qian J. Dexmedetomidine protects aged rats from postoperative cognitive dysfunction by alleviating hippocampal inflammation. Molecular Medicine Reports. 2019. doi:10.3892/mmr.2019.10438
Li R, Lai IK, Pan JZ, Zhang P, Maze M. Dexmedetomidine exerts an anti-inflammatory effect via α2 adrenoceptors to prevent lipopolysaccharide-induced cognitive decline in mice. Anesthesiology. 2020;133(2):393-407. doi:10.1097/aln.0000000000003390
Luo SM, Li LY, Guo LZ, Wang L, Wang YF, Chen N, et al. Dexmedetomidine exerts an anti-inflammatory effect via α2 adrenoceptors to alleviate cognitive dysfunction in 5xfad mice. Frontiers in Aging Neuroscience. 2022;14. doi:10.3389/fnagi.2022.9787687.
Kilminster S, Treasure T, McMillan T, Holt DW. Neuropsychologi-cal change and S-100 protein release in 130 unselected patients undergoing cardiac surgery. Stroke. 1999;30: 1869–74. DOI: 10.1161/01.str.30.9.1869
Kok WF, Koerts J, Tucha O, Scheeren TW, Absalom AR. Neuronal damage biomarkers in the identification of patients at risk of long-term postoperative cognitive dysfunction after cardiac surgery. Anaesthesia. 2017. 72: 359-369. doi:10.1111/anae.13712
Evered L, Silbert B, Scott DA, Ames D, Maruff P, Blennow K. Cerebrospinal Fluid Biomarker for Alzheimer Disease Predicts Postoperative Cognitive Dysfunction. Survey of Anesthesiology. 2016. doi:10.1097/01.sa.0000489968.05224.a9.
Danielson M, Wiklund A, Granath F, Blennow K, Mkrtchian S, Nellgård B, et al. Association between cerebrospinal fluid biomarkers of neuronal injury or amyloidosis and cognitive decline after major surgery. British journal of anaesthesia. 2020. doi:10.1016/j.bja.2020.09.043.
Clark MR. Pharmacological treatments for chronic non-malignant pain. International Review of Psychiatry. 2000;12(2):148-156. doi:10.1080/09540260050007453
Kudoh A, Takase H, Takazawa T. A comparison of anesthetic quality in propofol-spinal anesthesia and propofol-fentanyl anesthesia for total knee arthroplasty in elderly patients. Journal of Clinical Anesthesia. 2004;16(6):405-410. doi:10.1016/j.jclinane.2003.10.003
Allegri N, Mennuni S, Rulli E, Vanacore N, Corli O, Floriani I, et al. Systematic review and meta‐analysis on neuropsychological effects of long‐term use of opioids in patients with chronic noncancer pain. Pain Practice. 2018;19(3):328-343. doi:10.1111/papr.12741
Lam D, Sebastian A, Bogguri C, Hum NR, Ladd A, Cadena J, et al. Dose-dependent consequences of sub-chronic fentanyl exposure on neuron and glial co-cultures. Frontiers in Toxicology. 2022;4. doi:10.3389/ftox.2022.983415
Figueiredo S, Devezas CM. Bridging the Gaps in Understanding POD and POCD: A Thorough Examination of Genetic and Clinical Biomarkers. Perioperative care and operating room management. 2024;35(5):100401–1. DOI:10.1016/j.pcorm.2024.100401
Greaves D, Psaltis PJ, Lampit A, Davis DHJ, Smith AE, Bourke A, et al. Computerised cognitive training to improve cognition including delirium following coronary artery bypass grafting surgery: protocol for a blinded randomised controlled trial. BMJ Open. 2020;10(2):e034551. doi:10.1136/bmjopen-2019-034551
Butz M, Meyer R, Gerriets T, Sammer G, Doerr JM, El-Shazly J, et al. Increasing preoperative cognitive reserve to prevent postoperative delirium and postoperative cognitive decline in cardiac surgical patients (incore): study protocol for a randomized clinical trial on cognitive training. Frontiers in Neurology. 2022;13. doi:10.3389/fneur.2022.1040733
Saleh AJ, Tang GX, Hadi SM, Yan L, Chen MH, Duan KM, et al. Preoperative cognitive intervention reduces cognitive dysfunction in elderly patients after gastrointestinal surgery: a randomized controlled trial. Medical Science Monitor. 2015;21:798-805. doi:10.12659/msm.893359