Associated Factors of Postoperative Cognitive Dysfunction: A Literature Review

Main Article Content

Arunotai Siriussawakul

Abstract

Postoperative Cognitive Dysfunction (POCD) is defined as declining of one or more discrete areas of mental state postoperatively. The pathogenesis is unclear, but the most possible is inflammatory process in the brain. There is no specific treatment. Hence, POCD prevention by adjusting risk and protective factors should be conducted. This literature review shows 3 groups of associated factors. First, patient risk factors are old age, low education level, history of anticholinergic or sedative drugs usage, neurological diseases, diabetes mellitus, renal disease, carrier of ApoE ε4 gene, delirium, Systemic Inflammatory Response Syndrome and anemia. Second, anesthetic risk factors are benzodiazepine and high amount of opioid usage. Anesthetic protective factors are the usage of dexmedetomidine, ketamine, parecoxib, monitoring depth of anesthesia, patient-controlled epidural analgesia, and peripheral nerve block. Third, surgical risk factors are cardiac surgery, major surgery, long duration of surgery, blood loss and long waiting time before surgery. Previous studies have shown that these factors contributed differently to POCD, but the results were mostly modest. These studies are heterogeneity due to lack of definite diagnosis criteria of POCD. The further large and welldesigned studies are needed to confirm this association

Downloads

Download data is not yet available.

Article Details

Section
Review articles

References

1. Rasmussen LS, Larsen K, Houx P, Skovgaard LT, Hanning
CD, Moller JT. The assessment of postoperative cognitive
function. Acta Anaesthesiol Scand 2001;45:275-89.
2. Bedford PD. Adversecerebraleffectsofanaesthesiaonold
people.Lancet1955;269:259-63.
3. Norkiene I, Samalavicius R, Misiuriene I, Paulauskiene K,
Budrys V, Ivaskevicius J. Incidence and risk factors for
early postoperative cognitive decline after coronary artery
bypass grafting. Medicina(Kaunas)2010;46:460-4.
4. CanetJ, RaederJ, RasmussenLS,etal.Cognitive dysfunction
after minor surgery in the elderly. Acta Anaesthesiologica
Scandinavica2003;47:1204-10.
5. Daiello LA, Racine AM, Yun Gou R, et al. Postoperative
delirium and postoperative cognitive dysfunction: overlap
and divergence. Anesthesiology2019;131:477-91.
6. HudetzJA, Iqbal Z, Gandhi SD,etal. Postoperativecognitive
dysfunctioninolder patients withahistoryofalcoholabuse.
Anesthesiology2007;106:423-30.
7. Evered L, Silbert B, Knopman DS, et al. Recommendations
for the nomenclature of cognitive change associated with
anaesthesia and surgery-2018. Acta Anaesthesiol Scand
2018;62:1473-80.
8. TerrandoN, ErikssonLI, RyuJK,etal. Resolving postoperative
neuroinflammation and cognitive decline. Ann Neurol
2011;70:986-95.
9. Li Y, He R, Chen S, Qu Y. Effect of dexmedetomidine on
early postoperativecognitive dysfunctionand peri-operative
inflammation in elderly patients undergoing laparoscopic
cholecystectomy. Exp Ther Med 2015;10:1635-42.
10. Zhang H, Wu Z, Zhao X, Qiao Y. Role of dexmedetomidine
inreducingtheincidenceofpostoperativecognitivedysfunction
caused bysevofluraneinhalationanesthesiainelderly patients
with esophageal carcinoma. J Cancer Res Ther 2018;14:
1497-502.
11. Peng L, Xu L, Ouyang W. Role of peripheral inflammatory
markers in postoperative cognitive dysfunction (POCD):
a meta-analysis. PLoS One2013;8:e79624.
12. NeedhamMJ,Webb CE, Bryden DC. Postoperativecognitive
dysfunction and dementia: what we need to know and do.
Br J Anaesth2017;119(suppl_1):i115-i25.
13. Vizcaychipi MP. Post-operative cognitive dysfunction:
pre-operative risk assessment and peri-operative risk
minimization: A pragmaticreview of theliterature.JIntensive
& Crit Care2016;02(02).
14. Feinkohl I, Winterer G, Spies CD, Pischon T. Cognitive
reserveand theriskof postoperativecognitive dysfunction.
Dtsch Arztebl Int2017;114:110-7.
15. Shoair OA, Grasso Ii MP, Lahaye LA, Daniel R, Biddle CJ,
Slattum PW. Incidence and risk factors for postoperative
cognitive dysfunction in older adults undergoing major
noncardiacsurgery: A prospectivestudy.J Anaesthesiol Clin
Pharmacol2015;31:30-6.
16. American Geriatrics Society. American Geriatrics Society
updatedBeersCriteriafor potentiallyinappropriatemedication
useinolderadults. J Am Geriatr Soc2012;60:616-31.
17. Silbert B, Evered L, Scott DA, et al. Preexisting cognitive
impairment is associated with postoperative cognitive
dysfunctionafterhipjointreplacementsurgery.Anesthesiology
2015;122:1224-34.
18. Knaak C, BrockhausWR, Spies C,etal. Presurgicalcognitive
impairment is associated with postoperative delirium and
postoperative cognitive dysfunction. Minerva Anestesiol
2020;86:394-403.
19. Monk TG, Weldon BC, Garvan CW, et al. Predictors of
cognitive dysfunction after major noncardiac surgery.
Anesthesiology2008;108:18-30.
20. MonkTG, Price CC. Postoperativecognitive disorders. Curr
Opin Crit Care2011;17:376-81.
21. Yeh YC, Kuo YT, Huang MF,etal. Associationof brain white
matter lesionsand atrophy withcognitivefunctioninchronic
kidney disease. Int J Geriatr Psychiatry2019;34:1826-32.
22. Kadoi Y, Goto F. Factors associated with postoperative
cognitive dysfunctionin patientsundergoing cardiacsurgery.
SurgeryToday2006;36:1053-7.
23. Miyagawa N, Baba T, Maekawa K, et al. Chronic kidney
diseaseand postoperativecognitive dysfunctionincoronary
surgical patients. Cardiovascular Anesthesia2017;21:123-9.
24. Feinkohl I, Winterer G, Pischon T. Diabetes is associated
withriskofpostoperativecognitivedysfunction:Ameta-analysis.
Diabetes Metab Res Rev2017;33(5).
25. Kadoi Y, Saito S, Fujita N, Goto F. Risk factors for cognitive
dysfunction after coronary artery bypass graft surgery in
patients with type 2 diabetes. J Thorac Cardiovasc Surg
2005;129:576-83.
26. He X,Long G, Quan C, Zhang B, ChenJ, Ouyang W. Insulin
resistance predicts postoperative cognitive dysfunction in
elderly gastrointestinal patients. Front Aging Neurosci
2019;11:197.
27. Nakao S, Yamamoto T, Kimura S, Mino T, Iwamoto T. Brain
whitematter lesionsand postoperativecognitive dysfunction:
areview. J Anesth2019;33:336-40.
28. Feinkohl I, Winterer G, Pischon T. Hypertension and risk of
post-operative cognitive dysfunction (POCD): A systematic
review and meta-analysis. Clin Pract Epidemiol Ment Health
2017;13:27-42.
29. Cao L, Wang K, Gu T, Du B, Song J. Association between
APOE epsilon4alleleand postoperativecognitive dysfunction:
A meta-analysis. Int J Neurosci2014;124:478-85.
30. BickelH,Gradinger R, Kochs E,FörstlH. Highriskofcognitive
and functional decline after postoperative delirium:
A three-year prospectivestudy. Dement Geriatr Cogn Disord
2008;26:26-31.
31. Goldberg TE, Chen C, Wang Y,etal. Associationof delirium
with long-term cognitive decline: A meta-analysis. JAMA
Neurology2020.
32. Ge Y, Ma Z, Shi H, Zhao Y, Gu X, Wei H. Incidenceand risk
factors of postoperative cognitive dysfunction in patients
underwent coronary artery bypass grafting surgery. Zhong
nan da xue xue bao Yi xue ban = Journal of Central South
University Medical sciences2014;39:1049-55.
33. Safavynia SA, Goldstein PA. The role of neuroinflammation
inpostoperativecognitivedysfunction:movingfromhypothesis
totreatment.Front Psychiatry2019;9:752.
34. RousselJKS. Postoperativecognitive dysfunction:anupdated
review.JournalofNeurology &Neurophysiology.2015;06(03).
35. KokL, Slooter AJ, Hillegers MH,van Dijk D, Veldhuijzen DS.
Benzodiazepine use and neuropsychiatric outcomes in the
ICU:asystematicreview. Crit Care Med 2018;46:1673-80.
36. Mansouri N, Nasrollahi K, Shetabi H. Preventionofcognitive
dysfunction after cataract surgery with intravenous
administrationofmidazolamand dexmedetomidineinelderly
patientsundergoing cataractsurgery.AdvBiomedRes2019;8:6.
37. Wang Y, Han R, Zuo Z. Dexmedetomidine-induced
neuroprotection: isit translational?Transl Perioper Pain Med
2016;1:15-9.
38. Yang W, Kong LS, Zhu XX, Wang RX,Liu Y, ChenLR. Effect
of dexmedetomidineon postoperativecognitive dysfunction
and inflammation in patients after general anaesthesia:
A PRISMA-compliant systematic review and meta-analysis.
Medicine(Baltimore)2019;98:e15383.
39. Zhang Y, Shan GJ, Zhang YX,etal. Propofolcompared with
sevoflurane general anaesthesia is associated with
decreased delayed neurocognitiverecoveryinolderadults.
Br J Anaesth2018;121:595-604.
40. Tang S, Huang W, Zhang K, Chen W, Xie T. Comparison of
effectsof propofolversussevofluranefor patientsundergoing
cardiopulmonary bypass cardiac surgery. Pak J Med Sci
2019;35:1072-5.
41. Kletecka J, Holeckova I, Brenkus P, Pouska J, Benes J,
ChytraI. Propofol versus sevofluraneanaesthesia:effecton
cognitive decline and event-related potentials. J Clin Monit
Comput2019;33:665-73.
42. Guo L, Lin F, Dai H, et al. Impact of sevoflurane versus
propofolanesthesiaon post-operativecognitive dysfunction
in elderly cancer patients: A double-blinded randomized
controlled trial. Med Sci Monit2020;26.
43. Miller D, Lewis SR, Pritchard MW, et al. Intravenous versus
inhalational maintenance of anaesthesia for postoperative
cognitiveoutcomesinelderly peopleundergoing non-cardiac
surgery. Cochrane Database Syst Rev2018;8:Cd012317.
44. Hovaguimian F, Tschopp C, Beck-Schimmer B, Puhan M.
Intraoperativeketamineadministrationto prevent delirium or
postoperative cognitive dysfunction: A systematic review
andmeta-analysis.ActaAnaesthesiolScand2018;62:1182-93.
45. DeKockM,Loix S,Lavand’homme P.Ketamineand peripheral
inflammation. CNS NeurosciTher2013;19:403-10.
46. ChenG, Zhou Y, ShiQ, Zhou H. Comparisonofearlyrecovery
and cognitive function after desflurane and sevoflurane
anaesthesia in elderly patients: A meta-analysis of
randomized controlled trials.JInt Med Res2015;43:619-28.
47. Davis N,LeeM,Lin AY,etal. Postoperativecognitivefunction
following general versus regional anesthesia: a systematic
review. J Neurosurg Anesthesiol2014;26:369-76.
48. BocskaiT, KovácsM, Szakács Z,etal. Isthe bispectral index
monitoring protective against postoperative cognitive
decline? A systematicreview with meta-analysis. PLoS ONE
2020;15(2).
49. Punjasawadwong Y, Chau-InW,LaopaiboonM, Punjasawadwong S, Pin-On P. Processed electroencephalogram and
evoked potential techniquesforameliorationof postoperative
deliriumand cognitive dysfunctionfollowing non-cardiacand
non-neurosurgical proceduresinadults. Cochrane Database
Syst Rev2018;5(5):Cd011283.
50. HouR,WangH,ChenL,Qiu Y,Li S. POCDin patientsreceiving
total knee replacement under deep vs light anesthesia:
A randomized controlled trial. Brain Behav2018;8:e00910.
51. Quan C, Chen J, Luo Y, et al. BIS-guided deep anesthesia
decreases short-term postoperative cognitive dysfunction
and peripheral inflammation in elderly patients undergoing
abdominal surgery. Brain Behav2019;9:e01238.
52. Farag E, Chelune GJ, Schubert A, Mascha EJ. Is depth of
anesthesia,asassessed by the Bispectral Index, related to
postoperative cognitive dysfunction and recovery? Anesth
Analg 2006;103:633-40.
53. Kristek G, RadošI, Kristek D,etal. Influenceof postoperative
analgesiaonsystemicinflammatoryresponseandpostoperative
cognitive dysfunction after femoral fractures surgery:
A randomized controlled trial. Reg Anesth Pain Med 2019;
44:59-68.
54. YanW, Mao H, Qiu P. Effectsof differentanalgesiaregimens
on early post-operative cognitive dysfunction in elderly
patientsundergoing radical resectionofcervicalcarcinoma.
Exp Ther Med 2019;18:1465-9.
55. Mei B, Zha H, Lu X, et al. Peripheral nerve block as a
supplement to light or deep general anesthesia in elderly
patients receiving total hip arthroplasty. Clin J Pain 2017;
33:1053-9.
56. Liang L. Intercostalnerve blockimproves postoperative pain
and cognitiveimpairment inelderly patients withesophageal
cancer.WorldChineseJournalofDigestology2018;26:609-15.
57. Awada HN, Luna IE, Kehlet H, Wede HR, Hoevsgaard SJ,
Aasvang EK. Postoperative cognitive dysfunction is rare
after fast-track hip- and knee arthroplasty - but potentially
related toopioid use. J Clin Anesth2019;57:80-6.
58. Wang Y, Sands LP, Vaurio L, Mullen EA, Leung JM. The
effects of postoperative pain and its management on
postoperativecognitive dysfunction. Am J Geriatr Psychiatry
2007;15:50-9.
59. Rasmussen LA, Ryhammer PK, Greisen J, Bhavsar RR,
Lorentzen AG, Jakobsen CJ. Ultrashort acting remifentanil
isnotsuperior tolong-acting sufentanil in preserving cognitive
function- A randomized study.J Clin Anesth2016;33:127-34.
60. Huang S, Hu H, Cai YH, Hua F. Effect of parecoxib in the
treatmentof postoperativecognitive dysfunction:asystematic
review and meta-analysis. Medicine2019;98:e13812.
61. Ortega-Loubon C, Herrera-Gomez F, Bernuy-Guevara C,
etal. Near-infrared spectroscopy monitoring incardiacand
noncardiac surgery: Pairwise and Network Meta-Analyses.
J Clin Med 2019;8(12).
62. PappaM,Theodosiadis N,Tsounis A, Sarafis P. Pathogenesis
and treatment of post-operative cognitive dysfunction.
Electron Physician2017;9:3768-75.
63. Brady K, Hogue CW. Intraoperativehypotensionand patient
outcome: does “one size fit all?”. Anesthesiology 2013;
119:495-7.
64. Krzych ŁJ, Pluta MP, Putowski Z, Czok M. Investigating
association between intraoperative hypotension and
postoperative neurocognitive disorders in non-cardiac
surgery: A comprehensivereview. J Clin Med 2020;9:1-24.
65. Feng X, HuJ, HuaF, Zhang J, Zhang L, Xu G.Thecorrelation
of intraoperative hypotension and postoperative cognitive
impairment:a meta-analysisof randomized controlled trials.
BMC Anesthesiology.2020;20(1).
66. Gold JP, Charlson ME,Williams-Russo P,etal. Improvement
of outcomes after coronary artery bypass. A randomized
trialcomparing intraoperativehighversus low meanarterial
pressure. J Thorac Cardiovasc Surg 1995;110:1302-11;
discussion11-4.
67. LangerT, Santini A, ZadekF,etal. Intraoperativehypotension
is not associated with postoperative cognitive dysfunction
in elderly patients undergoing general anesthesia for
surgery: results of a randomized controlled pilot trial. J Clin
Anesth2019;52:111-8.
68. Vedel AG, Holmgaard F, Rasmussen LS, et al. High-target
versus low-target blood pressure management during
cardiopulmonary bypassto preventcerebral injuryincardiac
surgery patients: a randomized controlled trial. Circulation
2018;137:1770-80.
69. Williams-RussoP,SharrockNigel E,MattisS,etal.Randomized
trial of hypotensive epidural anesthesia in older adults.
Anesthesiology1999;91:926.
70. Evered L, Scott DA, Silbert B, Maruff P. Postoperative
cognitive dysfunctionisindependentof typeofsurgeryand
anesthetic. Anesth Analg 2011;112:1179-85.
71. Newman S, StygallJ,Hirani S, Shaefi S,MazeM. Postoperative
cognitive dysfunctionafternoncardiacsurgery:asystematic
review. Anesthesiology2007;106:572-90.
72. FranckM,NerlichK,NeunerB,etal.Noconvincing association
between post-operative deliriumand post-operativecognitive
dysfunction:asecondaryanalysis. Acta Anaesthesiol Scand
2016;60:1404-14.
73. Tan CB, Ng J, Jeganathan R,etal. Cognitivechangesafter
surgery in the elderly: does minimally invasive surgery
influencetheincidenceof postoperativecognitivechanges
compared to open colon surgery? Dement Geriatr Cogn
Disord 2015;39:125-31.
74. Zhu SH,JiMH, Gao DP,LiWY, Yang JJ. Association between
perioperative blood transfusion and early postoperative
cognitive dysfunction in aged patients following total hip
replacement surgery. Ups J Med Sci2014;119:262-7.
75. Krenk L, Rasmussen LS, Kehlet H. Postoperative cognitive
dysfunctionafter fast-trackhip and kneearthroplasty. Anesth
Analg 2012;114:S290.