Faculty Opinions recommendation of Postoperative cognitive dysfunction in older patients with a history of alcohol abuse.

2007 ◽  
Author(s):  
Armin Schubert
Keyword(s):  
Alcohol Abuse ◽  
Cognitive Dysfunction ◽  
Older Patients ◽  
Postoperative Cognitive Dysfunction ◽  
History Of

Postoperative Cognitive Dysfunction in Older Patients with a History of Alcohol Abuse

2007 ◽  
Vol 106 (3) ◽  
pp. 423-430 ◽  
Author(s):  
Judith A. Hudetz ◽  
Zafar Iqbal ◽  
Sweeta D. Gandhi ◽  
Kathleen M. Patterson ◽  
Trevor F. Hyde ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cognitive Impairment ◽  
Alcohol Abuse ◽  
Executive Functions ◽  
Cognitive Dysfunction ◽  
Older Patients ◽  
Postoperative Cognitive Dysfunction ◽  
Noncardiac Surgery ◽  
History Of

Background Postoperative cognitive dysfunction (POCD) affects a significant number of patients and may have serious consequences for quality of life. Although POCD is most frequent after cardiac surgery, the prevalence of POCD after noncardiac surgery in older patients is also significant. The risk factors for POCD after noncardiac surgery include advanced age and preexisting cognitive impairment. Self-reported alcohol abuse is a risk factor for postoperative delirium, but its significance for long-term POCD has not been investigated. The goal of this study was to determine whether neurocognitive function is impaired after noncardiac surgery during general anesthesia in older patients with a history of alcohol abuse. Methods Subjects aged 55 yr and older with self-reported alcohol abuse (n = 28) and age-, sex-, education-matched nonalcoholic controls (n = 28) were tested using a neurocognitive battery before and 2 weeks after elective surgery (n = 28) or a corresponding time interval without surgery (n = 28). Verbal memory, visuospatial memory, and executive functions were assessed. A neurologic examination was performed to exclude subjects with potential cerebrovascular damage. Results Significant three-way interactions (analysis of variance) for Visual Immediate Recall, Visual Delayed Recall, Semantic Fluency, Phonemic Fluency, and the Color-Word Stroop Test implied that cognitive performance in the alcoholic group decreased after surgery more than it did in the other three groups. Conclusions The results suggest that a history of alcohol abuse in older patients presents a risk for postoperative cognitive impairment in the domains of visuospatial abilities and executive functions that may have important implications for quality of life and health risks.

scholarly journals Characteristics and Outcome Determinants of Hospitalized Older Patients with Cognitive Dysfunction

2022 ◽  
Vol 19 (1) ◽  
pp. 584
Author(s):  
Yi-Ting Chao ◽  
Fu-Hsuan Kuo ◽  
Yu-Shan Lee ◽  
Yu-Hui Huang ◽  
Shuo-Chun Weng ◽  
...  
Keyword(s):  
Cognitive Dysfunction ◽  
Daily Living ◽  
Older Patients ◽  
Mini Mental State Examination ◽  
Walking Speed ◽  
Cognitive Disorders ◽  
Score Change ◽  
History Of ◽  
State Examination ◽  
Auditory Impairment

Cognitive dysfunction commonly occurs among older patients during admission and is associated with adverse prognosis. This study evaluated clinical characteristics and outcome determinants in hospitalized older patients with cognitive disorders. The main outcomes were length of stay, readmission within 30 days, Barthel index (BI) score at discharge, BI score change (discharge BI score minus BI score), and proportion of positive BI score change to indicate change of activities of daily living (ADL) change during hospitalization. A total of 642 inpatients with a mean age of 79.47 years (76–103 years) were categorized into three groups according to the medical history of dementia, and Mini-Mental State Examination (MMSE) scores at admission. Among them, 74 had dementia diagnosis (DD), 310 had cognitive impairment (CI), and 258 had normal MMSE scores. Patients with DD and CI generally had a higher risk of many geriatric syndromes, such as multimorbidities, polypharmacy, delirium, incontinence, visual and auditory impairment, fall history, physical frailty. They had less BI score, BI score change, and proportion of positive BI score change ADL at discharge. (DD 70.0%, CI 79.0%), suggesting less ADL change during hospitalization compared with those with normal MMSE scores (92.9%; p < 0.001). Using multiple regression analysis, we found that among patients with DD and CI, age (p = 0.008) and walking speed (p = 0.023) were predictors of discharge BI score. In addition, age (p = 0.047) and education level were associated with dichotomized BI score change (positive vs. non-positive) during hospitalization. Furthermore, the number and severity of comorbidities predicted LOS (p < 0.001) and readmission (p = 0.001) in patients with cognitive disorders. It is suggested that appropriate strategies are required to improve clinical outcomes in these patients.

scholarly journals Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery

2020 ◽  
Author(s):  
Shahzad Shaefi ◽  
Puja Shankar ◽  
Ariel L. Mueller ◽  
Brian P. O’Gara ◽  
Kyle Spear ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cognitive Dysfunction ◽  
Cognitive Assessment ◽  
Older Patients ◽  
Postoperative Cognitive Dysfunction ◽  
Neurocognitive Function ◽  
Secondary Outcomes ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen

Background Despite evidence suggesting detrimental effects of perioperative hyperoxia, hyperoxygenation remains commonplace in cardiac surgery. Hyperoxygenation may increase oxidative damage and neuronal injury leading to potential differences in postoperative neurocognition. Therefore, this study tested the primary hypothesis that intraoperative normoxia, as compared to hyperoxia, reduces postoperative cognitive dysfunction in older patients having cardiac surgery. Methods A randomized double-blind trial was conducted in patients aged 65 yr or older having coronary artery bypass graft surgery with cardiopulmonary bypass. A total of 100 patients were randomized to one of two intraoperative oxygen delivery strategies. Normoxic patients (n = 50) received a minimum fraction of inspired oxygen of 0.35 to maintain a Pao2 above 70 mmHg before and after cardiopulmonary bypass and between 100 and 150 mmHg during cardiopulmonary bypass. Hyperoxic patients (n = 50) received a fraction of inspired oxygen of 1.0 throughout surgery, irrespective of Pao2 levels. The primary outcome was neurocognitive function measured on postoperative day 2 using the Telephonic Montreal Cognitive Assessment. Secondary outcomes included neurocognitive function at 1, 3, and 6 months, as well as postoperative delirium, mortality, and durations of mechanical ventilation, intensive care unit stay, and hospital stay. Results The median age was 71 yr (interquartile range, 68 to 75), and the median baseline neurocognitive score was 17 (16 to 19). The median intraoperative Pao2 was 309 (285 to 352) mmHg in the hyperoxia group and 153 (133 to 168) mmHg in the normoxia group (P &lt; 0.001). The median Telephonic Montreal Cognitive Assessment score on postoperative day 2 was 18 (16 to 20) in the hyperoxia group and 18 (14 to 20) in the normoxia group (P = 0.42). Neurocognitive function at 1, 3, and 6 months, as well as secondary outcomes, were not statistically different between groups. Conclusions In this randomized controlled trial, intraoperative normoxia did not reduce postoperative cognitive dysfunction when compared to intraoperative hyperoxia in older patients having cardiac surgery. Although the optimal intraoperative oxygenation strategy remains uncertain, the results indicate that intraoperative hyperoxia does not worsen postoperative cognition after cardiac surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Physiologic Measures In Patients with PTSD with and Without A Recent History of Alcohol Abuse

2007 ◽  
Author(s):  
Eileen Ahearn ◽  
Mary Mussey ◽  
Catherine Johnson ◽  
Amy Krohn ◽  
Timothy Juergens ◽  
...  
Keyword(s):  
Alcohol Abuse ◽  
Recent History ◽  
History Of

Postoperative Cognitive Dysfunction In Older Alcoholics

2007 ◽  
Author(s):  
Judith A. Hudetz ◽  
Diane Reddy ◽  
Kathleen Patterson ◽  
Anthony G. Hudetz ◽  
David C. Warltier
Keyword(s):  
Cognitive Dysfunction ◽  
Postoperative Cognitive Dysfunction
Sign in / Sign up

Export Citation Format

Share Document