Postoperative cognitive dysfunction – current preventive strategies
Authors Kotekar N, Shenkar A, Nagaraj R
Received 16 February 2018
Accepted for publication 29 July 2018
Published 8 November 2018 Volume 2018:13 Pages 2267—2273
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Richard Walker
Nalini Kotekar,1 Anshul Shenkar,2 Ravishankar Nagaraj3
1Department of Anaesthesiology, JSS Academy of Higher Education and Research, Mysore, Karnataka, India; 2Department of Anaesthesiology, AJ Medical College and Research Centre, Mangalore, Karnataka, India; 3Department of Surgery, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
Abstract: Improving trends in global health care have resulted in a steady increase in the geriatric population. However, as the population ages, surgery is being performed more frequently in progressively older patients and those with higher prevalence of comorbidities. A significant percentage of elderly patients experience transient postoperative delirium following surgery or long-term postoperative cognitive dysfunction (POCD). Increasing age, educational level, pre-existing mental health, and comorbidities are contributory factors. Comprehensive geriatric assessment provides an objective evaluation on overall medical, social, mental, and functional well-being with scope for preoperative optimization. Preventive strategies for POCD target the surgical and patient-related factors as well as the utilization of the concept of stress-free anesthesia and surgery, that is, Enhanced Recovery After Surgery. This includes care bundles and protocols for the perioperative period which improves outcomes in the elderly. Research on biomarkers of neural injury in POCD is gaining momentum. Pharmacologic agents such as acetylcholine esterase inhibitors promise to have a vital role in the management of POCD but exhibit undesired side effects. Interventions to reduce oxidative stress and neuroinflammation could prove beneficial. Preventive strategies, early recognition, and management of perioperative risk factors seems to be, by far, the best modality to deal with POCD till further progress in therapeutic interventions evolve.
Keywords: cognitive dysfunction, geriatric anesthesia, neuronal injury, neuroinflammation, enhanced recovery, prehabilitation
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