Postoperative Cognitive Dysfunction in Elderly Patients. an Integrated Psychological and Medical Approach

By Bodolea, Constantin; Hagau, Natalia et al. | Journal of Evidence-Based Psychotherapies, March 2008 | Go to article overview

Postoperative Cognitive Dysfunction in Elderly Patients. an Integrated Psychological and Medical Approach


Bodolea, Constantin, Hagau, Natalia, Coman, Ioan, Pintea, Sebastian, Cristea, Ioana Alina, Cristea, Tudor, Negrutiu, Sanda, Journal of Evidence-Based Psychotherapies


Abstract

The aim of the article is to review the latest progresses in the research of postoperative cognitive dysfunction (POCD) after cardiac and noncardiac surgery in elderly patients.

While it is not yet possible to provide definite answers to some questions regarding POCD and additional work is required before a complete understanding of the mechanisms involved, we investigate the definition criteria for POCD, its incidence, medical complications and the social impact of POCD following anaesthesia and surgery. The article also reviews the POCD risk factors and the recent advances in identifying specific POCD biomarkers as well as the vulnerable cognitive areas of POCD and the neuropsychological instruments most frequently used to define and to survey the long-term follow-up of POCD.

Keywords: cognitive dysfunction, neuropsychological tests, elderly

INTRODUCTION

Postoperative cognitive dysfunction (POCD) in the elderly patient is an unwanted complication of the postoperative period, relatively frequent and most of the time underestimated. POCD is particularly characterized, but not only, by the alteration of memory and concentration performances. It is, for the time being, only detectable through the usage of neuropsychological tests (Rasmussen et al. 2003).

Although it was described more than 50 years ago by Bedford (1955) and largely debated within various seminars and conferences, POCD remains a puzzle awaiting an answer. There are some major questions that we are trying to answer in the present article, reviewing some of the most relevant papers published on the topic: 1. Is POCD induced by a certain type of surgical interventions or by the anesthetic technique?; 2. Are there any risk factors which are specific to POCD development?; 3. Which areas of cognition are particularly affected within the POCD?; 4. Is there any genetic context which can favor or which can be related with a higher incidence of POCD?; 5. Are there any biological markers of diagnostic value in POCD?; 6. Which is the duration of POCD and to what extent is the quality of life of POCD patients affected?; 7. Which are the most appropriate instruments and neuropsychological tests to evaluate the postoperative cognitive decline?

Many of the published studies that relate to this topic are descriptive, involving relatively small groups of patients, without control groups and the conclusions are sometimes speculative.

We reviewed (no time limit, up to January 2008) the main medical English language databases, i.e. Embase, Medline, Cochrane Library, MD Consult and PsycInfo, the keywords being: POCD, anesth*, anaesth*, postoperat*, surg*, and cerebral dysfunction, neurocognitive, neuropschycholog*, neurobehaviour*, quality of life. We used the same inclusion criteria like the ones of the recent review of Newman et al. (2001): a. patients undergoing cardiac and non-cardiac surgery; b. the evaluation of the cognitive function after more than 7 days, postoperatively (to differentiate the POCD by a postoperative delirium and to minimize the influence of the residual effect of the neurodepressive perioperative medication). Carotid vascular reconstructive surgery was used as an exclusion criterion. A number of 38 studies have been identified which met the above mentioned criteria. Out of these, 21 are cohort studies, divided as follows: 8 studies without control group, with the POCD evaluated as compared to preoperative status; 13 studies with control group. The remaining 17 studies (most of them randomized) compared groups of patients undergoing different anesthetic techniques (general, regional, local or other) for major or minor surgical procedures.

DEFINING POCD

The POCD definition should start with a clear differentiation between POCD and postoperative delirium. The postoperative delirium is a fluctuant and transitory alteration of consciousness, developed within the immediate postoperative period; the diagnosis of POCD can only be established in the later postoperative period and the cognitive decline has an insidious and slower onset, requiring evaluation through neurocognitive tests (Bryson et al. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Postoperative Cognitive Dysfunction in Elderly Patients. an Integrated Psychological and Medical Approach
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.