Perioperative Cognition in the Elderly: A Matter not to be Overlooked

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Pattharaporn Sombood
Kornnika Yangan
Phongthara Vichitvejpaisal

Abstract

Abnormal nervous and brain changes in the elderly are due to the neuronal death and neurotransmitters cut off, resulting in cognitive dysfunction such as attention and concentration, language, orientation and memory. In clinical practice, delirium, mild cognitive impairment and dementia are easily aggravated by surgery and general anesthesia which is known as postoperative cognitive dysfunction. A patient with acute physical illness simply gets lost in the ensuing confusion or state of delirium. However, an appropriate treatment might restore him/her to full health. Nevertheless, pathological brain or drugs abuse can cause precocious nervous disorder as mild cognitive impairment. Yet, a patient still has enough strength to survive. Additionally, a consequence owing to vicious cycle of neurons destruction is dementia. As such, a patient loses memory as anterograde and retrograde amnesia, fails to live on daily rounds and independent function, declines movement and death. By and large, postoperative cognitive dysfunction is detected in various age group, low-educated and mental-ill patients undergoing prolong surgical operation and general anesthesia. Necessarily, most cognitive function assessments such as Mini-Mental Status Test are performed by a neuropsychological expert. Interestingly, the Montreal Cognitive Assessment with informative sensitivity and specificity is considered a bedside screening tool by a trained, general practitioner. In perioperative care of the elderly, anesthesia personnel should have understanding of pathophysiologic age-related changes and drug-disease interactions resulting in upsurge of surgical-anesthesia stress. Notably, the consultation with surgeon and other specialists, pre and postoperative neuropsychological assessment and differential diagnostic procedure of particular, organic disease are highly effective management to bring back patient’s daily routine and lifestyle as well as to decrease the mortality rate.

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