scholarly journals Postoperative cognitive dysfunction in patients of the elderly and old age operated for composition of objective cancer

2021 ◽  
Vol 16 (1) ◽  
pp. 37-42
Author(s):  
Nikolay Glushkov ◽  
◽  
Timofey Gorshenin ◽  
Mariya Privalova ◽  
Grigoriy Gugalev ◽  
...  
Keyword(s):  
Cognitive Dysfunction ◽  
Postoperative Period ◽  
Depressive Disorders ◽  
Postoperative Cognitive Dysfunction ◽  
Cognitive Disorders ◽  
The Elderly ◽  
Cognitive Status ◽  
Control Group ◽  
Operative Trauma ◽  
State Examination

The problem of preserving the quality of life in the postoperative period, one of the criteria of which is the cognitive function, retains its relevance. In patients with advanced and senile age, after undergoing surgery, cognitive disorders are swept aside, which, according to various authors, reaches 64 %. Postoperative cognitive dysfunction was studied in 168 elderly and elderly patients operated on for complications of colon cancer. Patients were divided into two groups. Patients of the control group were operated on operations conventionally, the main one — laparoscopically, using endovideosurgical technologies. Cognitive status was assessed before the operation, as well as on the first, third and seventh days of the postoperative period using the MMSE test (abbr. English Mini Mental State Examination). The incidence of postoperative cognitive dysfunction in both groups was traced. In the development of postoperative cognitive disorders, along with such factors as general anesthesia, age, aggravated neurological history, depressive disorders, operative trauma plays an important role. The use of endoscopic technologies allows reliably reducing the risk of postoperative cognitive impairment, which in turn has a beneficial effect on the postoperative period.

scholarly journals Effect of General Versus Spinal Anesthesia on Postoperative Delirium and Early Cognitive Dysfunction in Elderly Patients

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Roghayeh Ehsani ◽  
Soudabeh Djalali Motlagh ◽  
Behrooz Zaman ◽  
Saloumeh Sehat Kashani ◽  
Mohammad Reza Ghodraty
Keyword(s):  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Cognitive Dysfunction ◽  
Postoperative Cognitive Dysfunction ◽  
The Elderly ◽  
Academic Hospitals ◽  
The Impact ◽  
To Receive ◽  
State Examination ◽  
Trial Setting

Background: Postoperative cognitive dysfunction (POCD) and delirium are common in the elderly patients, given the controversial results of previous studies about the impact of anesthesia type on the occurrence of these complications. Objectives: This study was planned to compare the effects of general and spinal anesthesia on the prevalence of POCD and delirium. Methods: A single-blind non-randomized clinical trial. Setting was in two academic hospitals. Ninety-four patients over 50 years old scheduled for hip fracture fixation. Patients were divided into two groups to receive either general (GA) or spinal (SA) anesthesia. Both Mini-Mental State examination (MMSE) and Wechsler tests were used before the operation and 3 times postoperatively to assess the cognitive function and detect early POCD. The DSM-IV criteria were also used for the diagnosis of delirium. The incidence of delirium and POCD and their precipitating factors were compared between the two groups. Results: Ninety-four patients with a mean age of 67.12 years were studied. The overall prevalence of POCD and delirium was 17.02%; however, it was significantly higher in the GA group rather than the SA group, 29.7%, and 4.25%, respectively (P < 0.001). There was a significant relationship between age (P = 0.048), ASA class (P = 0.034), and educational level with the incidence of POCD, meaning that the probability of developing cognitive impairment decreases with patients’ higher level of education and lower ASA-physical status. Also, the rate of POCD in men was significantly higher than in women (P = 0.026). Conclusions: The finding of this study showed that, if there is no specific contraindication, neuraxial anesthesia may be preferred over general anesthesia in elderly patients.

Changing Pain Management Strategy from Opioid-Centric towards Improve Postoperative Cognitive Dysfunction with Dexmedetomidine

2021 ◽  
Vol 22 ◽  
Author(s):  
Chunhong Su ◽  
Xiaojun Ren ◽  
Hongpei Wang ◽  
Xiaomei Ding ◽  
Jian Guo
Keyword(s):  
Pain Management ◽  
Cognitive Dysfunction ◽  
Postoperative Cognitive Dysfunction ◽  
Control Group ◽  
Pain Anxiety ◽  
Quality Of Recovery ◽  
Catastrophic Thinking ◽  
Lower Pain ◽  
State Examination

Objective: This study was aimed to investigate the effectiveness of dexmedetomidine (DEX) on improving the level of pain and disability to find out the possible correlation between psychological factors with pain management satisfaction and physical function in patients with femoral neck fractures. Methods: One hundred twenty-four adult patients with stable femoral neck fractures (type I and II, Garden classification) who underwent internal fixation, were prospectively enrolled including 62 patients in the DEX group and 62 patients in the control group. The magnitude of disability using Harris Hip Score, Postoperative Cognitive Dysfunction (POCD) using Mini-Mental State Examination (MMSE score), Quality of Recovery (QoR-40), pain-related anxiety (PASS-20), pain management and pain catastrophizing scale (PCS) were recorded on the first and second day after surgery. Results: The DEX group on the first and second days after surgery exhibited higher quality of recovery scores, greater satisfaction with pain management, low disability scores, less catastrophic thinking, lower pain anxiety, greater mini mental state examination scores and less opioid intake and the differences were statistically significant compared with the control group (P<0.001). Emergence agitation and incidence of POCD were significantly less in the DEX group (P<0.001). Decreased disability was associated with less catastrophic thinking and lower pain anxiety, but not associated with more opioid intake (P<0.001). Higher QoR-40 scores had a negative correlation with more catastrophic thinking and more opioid intake (P<0.001). Greater satisfaction with pain management was correlated with less catastrophic thinking and less opioid intake (P<0.001). Conclusion: Using DEX as an adjunct to anesthesia could significantly improve postoperative cognitive dysfunction and the quality of recovery and these improvements were accompanied by decrease in pain, emergence agitation, and opioid consumption by DEX administration. Since pain relief and decreased disability were not associated with prescribing greater amounts of opioid intake in the patients, improving psychological factors, including reducing catastrophic thinking or self-efficacy about pain, could be a more effective strategy to reduce pain and disability, meanwhile reducing opioid prescription in the patients. Our findings showed that DEX administration is safe sedation with anti-inflammatory, analgesic and antiemetic effects and it could help change pain management strategy from opioid-centric towards improved postoperative cognitive dysfunction.

Preexisting Cognitive Impairment Is Associated with Postoperative Cognitive Dysfunction after Hip Joint Replacement Surgery

2015 ◽  
Vol 122 (6) ◽  
pp. 1224-1234 ◽  
Author(s):  
Brendan Silbert ◽  
Lisbeth Evered ◽  
David A. Scott ◽  
Stephen McMahon ◽  
Peter Choong ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Cognitive Dysfunction ◽  
Hip Joint ◽  
Joint Replacement ◽  
Neuropsychological Tests ◽  
Postoperative Cognitive Dysfunction ◽  
Cognitive Status ◽  
Control Group ◽  
Hip Joint Replacement

Abstract Background: This study investigated the prevalence of cognitive impairment in elderly noncardiac surgery patients and any association between preoperative cognitive impairment and postoperative cognitive dysfunction (POCD). Additionally, the incidence of cognitive decline at 12 months after surgery was identified. Methods: Three hundred patients for hip joint replacement and 51 nonsurgical controls aged 60 yr or older were studied in a prospective observational clinical trial. All study participants and controls completed a battery of eight neuropsychological tests before surgery and at 7 days, 3 months, and 12 months afterwards. Preoperative cognitive status was assessed using preexisting cognitive impairment (PreCI) defined as a decline of at least 2 SD on two or more of seven neuropsychological tests compared to population norms. POCD and cognitive decline were assessed using the reliable change index utilizing the results of the control group. Results: PreCI was classified in 96 of 300 (32%) patients (95% CI, 23 to 43%). After surgery, 49 of 286 (17%) patients (95% CI, 13 to 22%) and 27 of 284 (10%) patients (95% CI, 6 to 13%) demonstrated POCD at 7 days and 3 months, respectively, while 7 of 271 (3%) patients (95% CI, 1 to 4%) demonstrated cognitive decline at 12 months. Patients with PreCI had a significantly increased incidence of POCD at 7 days and 3 months and cognitive decline at 12 months. Conclusions: Patients with PreCI have an increased incidence of POCD and cognitive decline. PreCI is a good predictor of subsequent POCD and cognitive decline. The incidence of cognitive decline after 12 months in this group of patients is low.

Prevention of cognitive disorders in the postoperative period in preschoolers

2020 ◽  
Vol 15 (4) ◽  
pp. 92-99
Author(s):  
L.S. Zolotareva ◽  
◽  
O.N. Paponov ◽  
S.M. Stepanenko ◽  
A.V. Adler ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Postoperative Period ◽  
Cognitive Functions ◽  
Postoperative Cognitive Dysfunction ◽  
Cognitive Disorders ◽  
Cognitive Outcomes ◽  
Control Group ◽  
Balanced Anesthesia ◽  
Key Words Anesthesia ◽  
Experimental Group

Surgeries under general anesthesia may result in reduced cognitive functions in children, which is important for child development Objective. To assess the incidence of cognitive disorders in children aged 3 to 7 years after intraoperative combined balanced anesthesia and to evaluate the efficacy of Cytoflavin in preventing them. Patients and methods. This study included 85 children who had undergone surgery (adenoidectomy and/or tonsillectomy) under general combined balanced anesthesia (sevoflurane, nitrous oxide, rocuronium bromide, fentanyl, and dexamethasone). The patients were randomized into two groups: control group (n = 40) and experimental group, in which children additionally received one infusion of cytoflavin intraoperatively (n = 44). All patients underwent comprehensive testing with the assessment of various cognitive functions before surgery, 24 hours postoperatively, and one month postoperatively. Results. Cognitive disorders were observed in 6%–10% of children after general anesthesia. The main manifestations of cognitive deficits in the postoperative period, such as impaired concentration, were most significant 24 hours postoperatively, but were eliminated one month later. A total of 7.1% of children demonstrated at least 20% decrease of their attention after surgery under general balanced anesthesia (confirmed by at least 3 tests). Six percent of children had a 20% decrease in their memory 24 hours postoperatively (confirmed by 2 tests). Cytoflavin improved cognitive performance 24 hours postoperatively, while patients in the control group had no significant changes. However, administration of cytoflavin had no significant impact on the incidence of cognitive deficit. Further studies are needed to identify children at risk who require prevention of cognitive disorders associated with anesthesia. Key words: anesthesia in children, anesthetics, pediatric surgery, cognitive outcomes, nicotinamide, postoperative cognitive dysfunction, cytoflavin

Relation between cognitive disorders and type of physical activity: Results of the FréLE cohort

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Dupré ◽  
N Barth ◽  
A El Moutawakkil ◽  
F Béland ◽  
F Roche ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cognitive Decline ◽  
Proportional Hazards ◽  
Cognitive Disorders ◽  
The Elderly ◽  
Cognitive Status ◽  
Global Test ◽  
Professional Activities ◽  
Beneficial Effects ◽  
The Impact

Abstract Background Few previous cohorts have studied the different type of physical activities and the degree of cognitive decline. The objective of this work was to analyze the leisure, domestic and professional activities with mild and moderate cognitive disorders in older people living in community. Methods The study used data from the longitudinal and observational study, FrèLE (FRagility: Longitudinal Study of Expressions). The collected data included: socio-demographic variables, lifestyle, and health status (frailty, comorbidities, cognitive status, depression). Cognitive decline was assessed by using: MMSE (Mini-Mental State Examination) and MoCA (Montreal Cognitive Assessment). MoCA was used with two cut-offs (26 and 17) so as to define mild and moderate cognitive disorders Physical activity was assessed by the PASE (Physical Activity Scale for the Elderly), structured in three sections: leisure, domestic and professional activities. Spline and proportional hazards regression models (Cox) were used to estimate the risk of cognitive disorders. Results At baseline, 1623 participants were included and the prevalence of cognitive disorders was 6.9% (MMSE) and 7.2% (MoCA), mild cognitive disorders was 71.3%. The mean age was 77 years, and 52% of the participants were women. After a 2 years long follow-up, we found 6.9% (MMSE) and 6% (MoCA) cognitive disorders on participants. Analyses showed that domestic activities were associated to cognitive decline (HR = 0.52 [0.28-0.94] for MMSE and HR = 0.48 [0.28-0.80] for MoCA). No association were found with leisure and professional activities, and no spline were significant with mild cognitive disorders. Conclusions Analysis showed a relationship between cognitive disorders and type of physical activity, thanks to the use of specific questionnaire of elderly and two global test of cognition. These findings will contribute to the debate on the beneficial effects of physical activity on cognition. Key messages This work allowed to compare two test of cognition and their link with physical activity. It contributes to the debate on the beneficial effects of physical activity on cognition. The work allowed us to see the effect of the different types of physical activity and the impact of the statistical method on the results.

scholarly journals Study of cognitive functions in major idiopathic interstitial pneumonias

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Mohamed W. Zakaria ◽  
Reem I. El-Korashy ◽  
Mostafa O. Shaheen ◽  
Samah Selim ◽  
Kwashi J. Amum
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Dysfunction ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
Control Group ◽  
Healthy Individuals ◽  
Co Morbidity ◽  
Impaired Lung Function ◽  
State Examination

Abstract Background Cognitive dysfunction in idiopathic interstitial pneumonia (IIP) is an important clinical co-morbidity that is associated with impaired lung function. The aim of the work is to assess cognitive function in major IIP and to find out the relation between cognitive dysfunction and the oxygenation parameters. Results Fifty individuals were involved in the study; 30 patients with major IIP and 20 healthy individuals. Patients with IIP had significantly lower mini mental state examination (MMSE) score compared to the control group (P < 0.001). Wechsler Deterioration Index (WDI) revealed that 33.3% (n = 10) of the patients with IIP had sure cognitive impairment and 26.6% (n = 8) had ongoing cognitive deterioration. Patients with idiopathic pulmonary fibrosis (IPF) had lower cognitive function than other IIP. Conclusion There is an impairment of cognitive function in patients with major IIP, particularly in IPF, as measured by WDI and MMSE. Further large studies are needed to assess the possible predictors of cognitive impairment and their effects on the patients’ outcome.

scholarly journals Effects of L-655,708 on expression changes of GABA, glutamate, and beta-endorphin induced by propofol anesthesia in rats

2018 ◽  
Vol 16 ◽  
pp. 205873921879670
Author(s):  
Jin Wang ◽  
Xinyi Li ◽  
Huisheng Wu ◽  
Jianjuan Ke ◽  
Zongze Zhang ◽  
...  
Keyword(s):  
Dentate Gyrus ◽  
Cognitive Dysfunction ◽  
Sham Group ◽  
Postoperative Cognitive Dysfunction ◽  
Expression Level ◽  
Control Group ◽  
Beta Endorphin ◽  
Anesthetized Rats ◽  
Significant Difference ◽  
Dentate Gyrus Region

Anesthetics are considered to be one of the important inducing factors of postoperative cognitive dysfunction (POCD). The hippocampal region of the rat is one of the action sites of general anesthesia drugs. L 655,708, a reverse agonist of gamma aminobutyric acid (GABA) receptor, can significantly improve short-term memory dysfunction in mice after anesthetized with isoflurane. So the purpose of this study is to investigate the effects of L-655,708 on expression of GABA, glutamate (GLU), and beta-endorphin (β-EP) in the dentate gyrus region of the hippocampus and cognition of rats anesthetized with propofol. In all, 30 male Sprague–Dawley (SD) rats were randomly allocated into the control group, sham group, and L-655,708 group, with 10 in each group. The cognitive function of rats was measured by Morris water maze before and 1 h after administration. Then the rats were sacrificed for brain tissues. Immunohistochemistry was used to study the expression of GABA, GLU, and β-EP in the hippocampus of anesthetized rats in each group. Compared with the control group, the latency of the sham group and L-655,708 group were significantly prolonged after administration ( P < 0.05). However, L-655,708 could shorten the prolonged latency ( P < 0.05). There was no significant difference in times of accessing original platform area between the three groups before and after medication ( P > 0.05). The expression level of GABA in the dentate gyrus region of hippocampus of rats in the sham group was significantly higher than that in the control group ( P < 0.05), while the expression level in the L-655,708 group was significantly lower than that in the sham group ( P < 0.05). No significant difference was found in the expression of GLU in the dentate gyrus region of hippocampus of rats in each group ( P > 0.05). Compared with the control group, the expression of β-EP was significantly lower in the dentate gyrus region of the hippocampus of sham group rats ( P < 0.05). However, the expression of β-EP in the L-655,708 group was significantly higher than that in the sham group ( P < 0.05). Cognitive dysfunction in rats anesthetized with propofol may be related to high expression of GABA and low expression of β-EP in the hippocampus. The mechanism of L-655,708 in reducing the cognitive impairment in propofol anesthetized rats may be bound up with down-regulating the expression of GABA and increasing the expression of β-EP in the hippocampus.

scholarly journals COGNITIVE FUNCTIONS CONDITION OF POST-STROKE PATIENTS

2019 ◽  
pp. 16-21
Author(s):  
V. R. Gerasymchuk ◽  
I. F. Uwa-Agbonikhena ◽  
L. T. Maksymchuk ◽  
M. Yu. Kupnovytska-Sabadosh ◽  
T. I. Nehrych ◽  
...  
Keyword(s):  
Executive Functions ◽  
Mini Mental State Examination ◽  
Cognitive Status ◽  
Control Group ◽  
Clock Drawing Test ◽  
Drawing Test ◽  
Status Assessment ◽  
Trail Making ◽  
State Examination ◽  
Moca Score

60 patients after a hemispheric ischemic stroke (IS) were examined. Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Trail Making Test A and B (TMT), and the Clock Drawing Test (CDT) were used for the cognitive status assessment. A decrease in the MMSE, FAB and MoCA score compared to the control group (CG) (p<0.05) was observed, with probable differences mainly in the domains of attention (p<0.05) and executive functions (p<0.05). An increase in the time of task execution by 45.5% was detected for TMT A (p <0.05) and 61.9% for TMT B (p <0.01), and violation of CDT performance compared to the CG (p<0.05). Thus, the study of cognitive status using TMT and CDT may be recommended for timely detection of the initial executive functions impairment.

Peri-Operative Considerations of Dementia, Delirium, and Cognitive Decline

2019 ◽  
pp. 297-302
Author(s):  
Phillip E. Vlisides ◽  
Zhongcong Xie
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cognitive Decline ◽  
Postoperative Cognitive Dysfunction ◽  
Cognitive Disorders ◽  
The Elderly ◽  
Surgical Patients ◽  
Anaesthetic Agents ◽  
Study Methodology ◽  
The Many

As the elderly population increases, so will the number of surgical patients with dementia and other cognitive disorders. Laboratory evidence suggests that some commonly used anaesthetic agents may accelerate the Alzheimer’s disease (AD) process, but robust clinical research is still needed. This chapter discusses the need for peri-operative guidelines for patients with dementia, and the many opportunities for further research to inform such guidelines. It also covers postoperative delirium and its association with longer hospital and intensive care unit stays, cognitive decline after surgery, and higher mortality. Finally, it covers postoperative cognitive dysfunction (POCD), how standardized definitions and study methodology are lacking, and that studying cognitive trajectory after anaesthesia and surgery is often confounded by various clinical elements that cannot be accounted for methodologically.

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