Postoperative delirium and postoperative cognitive dysfunction: updates in pathophysiology, potential translational approaches to clinical practice and further research perspectives

2018 ◽  
Vol 84 (2) ◽  
Author(s):  
Marco CASCELLA ◽  
Maria R. MUZIO ◽  
Sabrina BIMONTE ◽  
Arturo CUOMO ◽  
Jan G. JAKOBSSON
Keyword(s):  
Clinical Practice ◽  
Cognitive Dysfunction ◽  
Postoperative Delirium ◽  
Postoperative Cognitive Dysfunction ◽  
Research Perspectives

Postoperative Delirium is Associated with Postoperative Cognitive Dysfunction at One Week after Cardiac Surgery with Cardiopulmonary Bypass

2009 ◽  
Vol 105 (3) ◽  
pp. 921-932 ◽  
Author(s):  
Judith A. Hudetz ◽  
Alison J. Byrne ◽  
Kathleen M. Patterson ◽  
Paul S. Pagel ◽  
David C. Warltier
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Cognitive Impairment ◽  
Cardiopulmonary Bypass ◽  
Cognitive Dysfunction ◽  
Postoperative Delirium ◽  
Postoperative Cognitive Dysfunction ◽  
Surgical Patients ◽  
Nonverbal Memory ◽  
Surgery Group

Postoperative delirium with cognitive impairment frequently occurs after cardiac surgery. It was hypothesized that delirium is associated with residual postoperative cognitive dysfunction in patients after surgery using cardiopulmonary bypass. Male cardiac surgical patients ( M age = 66 yr., SD = 8; M education = 13 yr., SD = 2) and nonsurgical controls ( M age = 62, SD = 7; M education = 12, SD = 2) 55 years of age or older were balanced on age and education. Delirium was assessed by the Intensive Care Delirium Screening Checklist preoperatively and for up to 5 days postoperatively. Recent verbal and nonverbal memory and executive functions were assessed (as scores on particular tests) before and 1 wk. after surgery. In 56 patients studied ( n = 28 Surgery; n=28 Nonsurgery), nine patients from the Surgery group developed delirium. In the Surgery group, the proportion of patients having postoperative cognitive dysfunction was significantly greater in those who experienced delirium (89%) compared with those who did not (37%). The odds of developing this dysfunction in patients with delirium were 14 times greater than those who did not. Postoperative delirium is associated with scores for residual postoperative cognitive dysfunction 1 wk. after cardiac surgery.

Presurgical cognitive impairment is associated with postoperative delirium and postoperative cognitive dysfunction

2020 ◽  
Vol 86 (4) ◽  
Author(s):  
Cornelia Knaak ◽  
Wolf-Rüdiger Brockhaus ◽  
Claudia Spies ◽  
Friedrich Borchers ◽  
Sophie K. Piper ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
Postoperative Delirium ◽  
Postoperative Cognitive Dysfunction

scholarly journals Postoperative Delirium and Postoperative Cognitive Dysfunction

2018 ◽  
Vol 129 (3) ◽  
pp. 389-391 ◽  
Author(s):  
Michael J. Devinney ◽  
Joseph P. Mathew ◽  
Miles Berger
Keyword(s):  
Cognitive Dysfunction ◽  
Postoperative Delirium ◽  
Postoperative Cognitive Dysfunction

scholarly journals Cerebral monitoring of anaesthesia on reducing cognitive dysfunction and postoperative delirium: a systematic review

2018 ◽  
Vol 46 (10) ◽  
pp. 4100-4110 ◽  
Author(s):  
Chunmei Luo ◽  
Weiwu Zou
Keyword(s):  
Systematic Review ◽  
Cognitive Dysfunction ◽  
Postoperative Delirium ◽  
Randomized Clinical Trials ◽  
Postoperative Cognitive Dysfunction ◽  
Auditory Evoked Potential ◽  
Cochrane Library ◽  
Significant Heterogeneity ◽  
Significant Difference

Objective To assess the efficacy of cerebrally monitoring the depth of anaesthesia in reducing postoperative cognitive dysfunction and postoperative delirium (POD). Methods MEDLINE, EMBASE, and Cochrane Library databases were searched following PRISMA statement guidelines. We included randomized clinical trials (RCTs) comparing electroencephalogram-based and routine care-guided titration of anaesthesia in a systematic review. The risk estimate from each RCT was pooled in a meta-analysis. The primary outcome was POD and long-term cognitive dysfunction. Subgroup analyses were conducted for the subtypes of intervention group and surgery. We identified five RCTs with a total sample size of 2,868 and with bispectral index (BIS) or auditory evoked potential (AEP) as interventions. Results The odds ratio (OR) for POD and long-term cognitive decline was 0.51 (95%CI: 0.35–0.76) and 0.69 (95%CI: 0.49–0.97), respectively. Significant heterogeneity was identified in the POD data. There was no significant difference between BIS- and AEP-based titration of anaesthesia in reducing the risk of POD. Extensive heterogeneity for cardiac and thoracic surgery was identified in the study population, and significant publication bias was found among the POD results. Conclusions BIS- and AEP-guided anaesthesia are associated with significantly reduced risk of POD and long-term cognitive dysfunction.

scholarly journals Processed Electroencephalogram Monitoring and Postoperative Delirium

2018 ◽  
Vol 129 (3) ◽  
pp. 417-427 ◽  
Author(s):  
Kristen K. MacKenzie ◽  
Angelitta M. Britt-Spells ◽  
Laura P. Sands ◽  
Jacqueline M. Leung
Keyword(s):  
Cognitive Dysfunction ◽  
Fixed Effects ◽  
Postoperative Delirium ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Risk Of Bias ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Google Search ◽  
The Relationship

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Postoperative delirium complicates approximately 15 to 20% of major operations in patients at least 65 yr old and is associated with adverse outcomes and increased resource utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia. This systematic review and meta-analysis examines the relationship between processed electroencephalogram monitoring and postoperative delirium and cognitive dysfunction. Methods A systematic search for randomized controlled trials was conducted using Ovid MEDLINE, PubMed, EMBASE, Cochrane Library, and Google search using the keywords processed electroencephalogram, Bispectral Index, postoperative delirium, postoperative cognitive dysfunction. Screening and data extraction were conducted by two independent reviewers, and risk of bias was assessed. Postoperative delirium combined-effect estimates calculated with a fixed-effects model were expressed as odds ratios with 95% CIs. Results Thirteen of 369 search results met inclusion criteria. Postoperative cognitive dysfunction data were excluded in meta-analysis because of heterogeneity of outcome measurements; results were discussed descriptively. Five studies were included in the quantitative postoperative delirium analysis, with data pooled from 2,654 patients. The risk of bias was low in three studies and unclear for the other two. The use of processed electroencephalogram-guided anesthesia was associated with a 38% reduction in odds for developing postoperative delirium (odds ratio = 0.62; P < 0.001; 95% CI, 0.51 to 0.76). Conclusions Processed electroencephalogram-guided anesthesia was associated with a decrease in postoperative delirium. The mechanism explaining this association, however, is yet to be determined. The data are insufficient to assess the relationship between processed electroencephalogram monitoring and postoperative cognitive dysfunction.

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