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Related Experiment Videos

Is peri-operative cortisol secretion related to post-operative cognitive dysfunction?

L S Rasmussen1, J T O'Brien, J H Silverstein

  • 1Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

Acta Anaesthesiologica Scandinavica
|September 9, 2005
PubMed
Summary

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Post-operative cognitive dysfunction (POCD) is linked to altered cortisol patterns after surgery. Flattening of the diurnal cortisol rhythm, indicated by reduced morning/afternoon ratios, is significantly associated with POCD development.

Area of Science:

  • Endocrinology
  • Neuroscience
  • Geriatric Medicine

Background:

  • Surgery significantly impacts cortisol secretion patterns.
  • Cortisol's neurotoxic potential suggests a role in post-operative cognitive dysfunction (POCD).
  • Hypothesis: POCD incidence correlates with cortisol level alterations.

Purpose of the Study:

  • To investigate the relationship between cortisol secretion patterns and POCD incidence.
  • To assess the impact of surgery on diurnal cortisol variation.
  • To determine if altered cortisol rhythms predict cognitive decline post-surgery.

Main Methods:

  • 187 patients over 60 undergoing major non-cardiac surgery were studied.
  • Salivary cortisol levels measured pre- and post-operatively (1 day, 7 days, 3 months).

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  • Cognitive function assessed using neuropsychological tests; POCD defined by a Z score > 1.96.

    • Main Results:

    • Salivary cortisol concentrations significantly increased post-surgery.
    • POCD detected in 18.8% at 1 week and 15.2% at 3 months.
    • A persistent flattening of the diurnal cortisol (am/pm) ratio post-operatively was significantly related to POCD at 1 week.

    Conclusions:

    • Diurnal cortisol variation patterns are significantly related to POCD.
    • Circadian rhythm disturbance or metabolic endocrine stress may drive post-surgical cognitive dysfunction.
    • Altered cortisol secretion is a potential mechanism underlying POCD.