Postoperative cognitive dysfunction: progress mechanisms and clinical characteristics

The article is devoted to the study of postoperative cognitive dysfunction — a syndrome that is often found in the postoperative period and does not depend on the volume of surgeon. Based on the analysis of the results of modern studies, the authors cite the most likely etiological causes of the syndrome, grouped according to different categories of risk factors. The pathogenetic algorithm for cognitive dysfunction includes the appearance of systemic inflammation, improving blood-brain barrier permeability with the endothelial dysfunction, the migration of inflammatory agents into the central nervous system, and the formation of oxidative stress. The clinical manifestations of cognitive deficit in the outcome of surgeon performed under general anesthesia, the authors illustrate with their own observations of patients with a neurosurgical profile with spinal pathology operated on with the use of propofol anesthesia, comparing the results of neuropsychological testing with an assessment of the level of anxiety. In conclusion, the authors outline a strategy for the prevention of postoperative cognitive dysfunction and recommend conducting neuropsychological rehabilitation as an important component of postoperative recovery for all patients with a diagnosed cognitive deficit that occurred after surgery.

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Postoperative agitation syndrome in young children with perinatal damage to the central nervous system

CHILD`S HEALTH ◽

10.22141/2224-0551.16.5.2021.239715 ◽

2021 ◽

Vol 16 (5) ◽

pp. 355-360

Author(s):

V.I. Snisar ◽

O.S. Pavlysh

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Young Children ◽

Postoperative Period ◽

Anesthetic Management ◽

Clinical Manifestations ◽

Postoperative Recovery ◽

Inhalation Anesthesia ◽

Ventriculoperitoneal Shunting ◽

The Central Nervous System

One of the complications of the postoperative period in children is postanesthetic agitation, a significant emotional and uncontrollable worry, clouding of consciousness, feeling of anxiety and fear, inappropriate behavior, irritability, inconsolable crying, aggressive and negative attitude towards parents and medical staff. Postoperative agitation is very important for clinicians and hospitals, it has a risk of harming a patient, staying longer in the ward after anesthesia, and increasing the period of postoperative recovery. The frequency of postoperative agitation depends on age group. Most often agitation occurs in young children. There is evidence that agitation can also be due to the immature nervous system and a consequence of pathological conditions of the central nervous system (asthenoneurotic syndrome, encephalopathy, hyperactivity syndrome, perinatal posthypoxic and organic brain lesions, history of prematurity, epilepsy, psychophysical and speech delay, etc.). That is why the goal of our research was to study the patterns of clinical manifestations of postoperative agitation syndrome in children with prenatal damage to the central nervous system. The work was performed based on the analysis of the postoperative period in 109 young children: 59 patients with acquired hydrocephalus, who underwent ventriculoperitoneal shunting, and 50 children without neurological disorders in whom reconstructive surgeries were carried out. Depending on the type anesthetic management, each group was divided into two subgroups: children, who received inhalation anesthesia with sevoflurane, and those, who received total intravenous anesthesia using propofol. In the postoperative period, the behavior of children was assessed on a Pediatric Anesthesia Emergence Delirium scale 30 minutes after anesthesia was completed. Criterion for the development of agitation was the presence of excitement in a child with a score of ≥ 10 points. Study showed that young children with perinatal damage to the central nervous system and children whose anesthetic provision is carried out using sevoflurane are the most vulnerable to the development of agitation syndrome. Agitation in such children is more pronounced and longer. These cases require prediction, detection and active surveillance.

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Influence of the type of anaesthetic support on the development of postoperative cognitive dysfunction in gynecologic oncology patients

Kazan medical journal ◽

10.17816/kmj2018-549 ◽

2018 ◽

Vol 99 (4) ◽

pp. 549-555

Author(s):

O M Basenko ◽

I N Nedbailo ◽

A A Astakhov ◽

A I Sinitskiy ◽

D G Voroshin

Keyword(s):

General Anesthesia ◽

Cognitive Dysfunction ◽

Epidural Anesthesia ◽

Neuropsychological Testing ◽

Postoperative Cognitive Dysfunction ◽

Inhalational Anesthesia ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test ◽

Combined Anesthesia

Aim. Determination of the influence of age and type of anesthesia on the patient’s cognitive abilities. Methods. 30 females who underwent surgical intervention were examined. The first group consisted of 14 patients who received general inhalational anesthesia, group 2 included 16 patients who received general inhalational anesthesia in combination with epidural anesthesia. All patients underwent neuropsychological testing at several stages: one day before the surgery, the first day after surgery, on day 28 after the surgery. Cognitive status was assessed using Mini-Mental State Examination (MMSE) and the clock-drawing test (CLOCK). Results. Given the combination of indices of both types of neuropsychological testing, postoperative cognitive dysfunction was diagnosed when a decrease by 10% or more of both MMSE and clock-drawing test and the MMSE score in patients with diagnosed postoperative cognitive dysfunction was less than 24 on both days 1 and 28. It should be noted that the results of testing before surgery in all groups of patients showed mild cognitive dysfunction. After the surgery, the measures of intellectual ability significantly decreased. The results of the analysis in the early recovery period in the group of patients who underwent combined anesthesia were significantly higher. And in the group of patients with combined anesthesia compared to the group that received only general anesthesia on day 28, cognitive indices were significantly higher: MMSE — pMW=0.041 and CLOCK — pMW Conclusion. General anesthesia combined with epidural anesthesia affects cognitive function of female patients less negatively than the use of general anesthesia alone.

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Postoperative Cognitive Dysfunction in Patients with Preoperative Cognitive Impairment

Anesthesiology ◽

10.1097/00000542-200703000-00006 ◽

2007 ◽

Vol 106 (3) ◽

pp. 431-435 ◽

Cited By ~ 49

Author(s):

Jeffrey H. Silverstein ◽

Jacob Steinmetz ◽

Abraham Reichenberg ◽

Philip D. Harvey ◽

Lars S. Rasmussen

Keyword(s):

Cognitive Impairment ◽

Cognitive Dysfunction ◽

Neuropsychological Testing ◽

Postoperative Cognitive Dysfunction ◽

International Study ◽

Total Sample ◽

Memory Test ◽

Cognitive Deterioration ◽

Neuropsychological Measures ◽

Interference Test

Background The authors explored the database of the first International Study of Postoperative Cognitive Dysfunction study to specify the domains of cognitive function that were most vulnerable and to determine the pattern of deterioration in patients with preoperative cognitive impairment. Methods One thousand two hundred eighteen patients were included in the first International Study of Postoperative Cognitive Dysfunction, where neuropsychological testing was performed at entry to the study, at 1 week, and at 3 months after surgery. The authors' analyses determined the extent to which seven neuropsychological measures changed after surgery with focus on the relation with preoperative cognitive impairment, defined as a preoperative score 1.5 SD below healthy controls in the memory test. Results Preoperative cognitive impairment was found in 74 patients at baseline. At 1 week, cognitive deterioration was seen in all tests, but in particular in the Letter Digit Coding and the time of the Stroop interference test, with 14% and 16% of the total sample (n = 1,016) exceeding 2 SD, respectively. At 3 months, deterioration was more uniform. Significantly fewer in the preoperative cognitive impairment group had deterioration in the memory test, both at 1 week and at 3 months, with no patient displaying a deterioration exceeding 2 SD. Conclusions Postoperative cognitive deterioration was seen in all tests, although most commonly in attention and cognitive speed at 1 week. Deterioration in memory was difficult to detect after surgery in patients with preoperative cognitive impairment.

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Postoperative cognitive dysfunction: A case report and literature review

Case Reports in Internal Medicine ◽

10.5430/crim.v4n4p37 ◽

2017 ◽

Vol 4 (4) ◽

pp. 37

Author(s):

Gurpreet Singh ◽

Margaret M Cinicola ◽

Naveen R Parva ◽

John T Cinicola ◽

Venkat G Muvva ◽

...

Keyword(s):

Cognitive Dysfunction ◽

Mental Status ◽

Artery Bypass ◽

Bypass Graft ◽

Postoperative Cognitive Dysfunction ◽

Clinical Manifestations ◽

Altered Mental Status ◽

Major Surgery ◽

Postoperative Cognitive Decline ◽

Prolonged Hospital

Background: Postoperative cognitive dysfunction (POCD) is loss of cognition especially in memory and executive function that can extend from a few days to a few weeks after surgery. It is more common in older adult patients. We present a case featuring a typical progression of POCD along with its associated preoperative risk factors.Case report: A 65-year-old male patient with an extensive past medical history including generalized anxiety disorder, hypertension and hyperlipidemia initially presented to the emergency department for chest pain. Coronary artery bypass graft (CABG) was performed under general anesthesia with Propofol, Fentanyl, Rocuronium and Midazolam. The patient tolerated the procedure well. After the procedure, his stay was complicated by delirium and altered mental status. All reversible causes were investigated and eliminated as likely causes. Later, the patient was sent home after a prolonged hospital stay. Following discharge, he had multiple admissions to the hospital for altered mental status, and his mental status has not reached baseline again. Family has been confident that the patient’s psychological and cognitive symptoms began following the CABG.Conclusion: We present this case to highlight the heightened incidence of postoperative cognitive decline in patients over sixty undergoing major surgery. We also present a comprehensive review of the current literature on the risk factors, clinical manifestations, and pathogenesis of POCD.

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Postoperative Cognitive Dysfunction and the Protective Effects of Enriched Environment: A Systematic Review

Neurodegenerative Diseases ◽

10.1159/000513196 ◽

2021 ◽

pp. 1-10

Author(s):

Momin Hua ◽

Jia Min

Keyword(s):

Cognitive Dysfunction ◽

Molecular Level ◽

Postoperative Cognitive Dysfunction ◽

Enriched Environment ◽

Surgical Patient ◽

Protective Effects ◽

Elderly Individuals ◽

The Central Nervous System ◽

Perioperative Complication ◽

Number Of Individuals

Background: Currently, the number of individuals who undergo surgery is greatly increased. As a consequence, postoperative cognitive dysfunction (POCD) has gradually gained more attention. Summary: POCD is a perioperative complication requiring sensitive preoperative and postoperative neuropsychiatric tests, and its incidence in both cardiac and noncardiac surgery is high, especially in elderly individuals. Surgical, patient, and anesthetic factors may all lead to the occurrence and development of POCD. The key mechanism of POCD may be the inflammatory response of the central nervous system during surgery, which is similar to that of Alzheimer’s disease (AD). Enriched environment (EE), a factor that can significantly improve and prevent neurodegenerative diseases, may have a beneficial effect on POCD. Key Messages: This review aims to elucidate the mechanism of the occurrence and development of POCD, analyze the possible influence of EE on POCD at the molecular level, and provide a direction for its treatment.

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Postoperative cognitive dysfunction: etiology, clinical features, diagnosis

Medical Council ◽

10.21518/2079-701x-2021-19-49-56 ◽

2021 ◽

pp. 49-56

Author(s):

S. P. Bordovsky ◽

P. M. Krupenin ◽

A. I. Rozen ◽

G. Yu. Evzikov ◽

Y. V. Kirichuk ◽

...

Keyword(s):

Cognitive Dysfunction ◽

Cognitive Functions ◽

Small Sample Size ◽

Postoperative Cognitive Dysfunction ◽

Clinical Manifestations ◽

Small Sample ◽

Aged Patients ◽

Memory Impairments ◽

Before And After ◽

The Relationship

Introduction. The present study analyzed the possibility of using neuropsychological tests to assess postoperative cognitive dysfunction. New data were obtained: in the postoperative period, hippocampal memory impairments predominate in patients, which makes it expedient to use methods for diagnosing primary modal-nonspecific memory disorders in patients who are to undergo neurosurgical intervention on the spinal cord.The aim of the study to evaluate the influence of surgery with anesthesia on the cognitive functions of middle-age patients.Materials and methods. The study included 20 middle-aged patients. All patients had to undergo spinal surgery. Patients received total intravenous anesthesia with propofol induction (4–12 mg/kg/hr). Cognitive functions before and after the operation were made with the use of the MoCA, TMT A and B, FCSRT, state-trait anxiety inventory test (STAI).Results. The development of POCD was noted in 15% of cases. The patients showed a decrease in the FCSRT prompt index (1st day = 87 ± 9.0; 2nd day = 83 ± 15; p = 0,0005), while the overall severity of cognitive impairments (total score of MoCA) did not change significantly (standard deviation according to MoCA: 24.25 ± 2.86 on day 1 and 24 ± 3.24 on the second day, p = 0.61). The RT level decreased by day 2: 44.65 ± 7.4 versus 41.1 ± 8.2 (p = 0.001). Correlation analysis did not show the relationship between the age of patients, education level, comorbidity and development of POCD; however, the duration of anesthesia was associated with a decrease in MoCA scores (Pearson’s correlation coefficient r = –0.44; p = 0.050).Conclusion. Thus, our study shows that the study of hippocampal memory impairments is important in patients with POCD. These data differ from the data of researchers presented earlier, where the most important clinical manifestations of POCD are considered to be a decrease in attention and speed of mental processes. Of course, the small sample size dictates the need for additional research.

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The cognitive dysfunction in patients with obesity. Role of the endocannabinoids

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2012-18-2-126-135 ◽

2012 ◽

Vol 18 (2) ◽

pp. 126-135

Author(s):

I. Zueva ◽

K. I. Vanaeva ◽

E. V. Shlyakhto

Keyword(s):

Cognitive Function ◽

Cognitive Dysfunction ◽

Evoked Potential ◽

Cognitive Deficit ◽

Neuropsychological Testing ◽

Endocannabinoid System ◽

Obese Patients ◽

Physiological Processes ◽

Design And Methods

The endocannabinoid system plays an important role in different physiological processes including memory and learning. Its activation can affect cognitive function and cause cognitive deficit in obese patients. Objective. To assess the association between cognitive function and activity of the endocannabinoid system in obese patients. Design and methods. 32 subjects (18 females and 14 males) aged 35-55 years old (mean age — 47,8 ± 2,3 years) were included in the study. All participants underwent neuropsychological testing, assessment of cognitive evoked potentials and plasma level of the endocannabinoids. Results. Our study showed that obese patients demonstrate cognitive dysfunction. Cognitive evoked potential is an objective and early sing of cognitive dysfunction. Activation of the endocannabinoid system is associated with cognitive deficit in obese patients.

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