[Postoperative cognitive dysfunction. Possible neuronal mechanisms and practical consequences for clinical routine].

Area of Science:

• Neuroscience
• Geriatric Medicine
• Anesthesiology

Context:

• Postoperative cognitive dysfunction (POCD) affects elderly patients after surgery, leading to prolonged cognitive decline.
• The exact mechanisms underlying POCD remain elusive, suggesting multifactorial causes.
• Current research explores the neurotoxic effects of anesthetics and surgery-induced neuroinflammation as potential contributors to POCD.

Purpose:

• To review the current understanding of the causes and potential mechanisms of postoperative cognitive dysfunction (POCD).
• To highlight the importance of perioperative physiological homeostasis in preventing POCD.
• To assess the current clinical evidence regarding anesthesiological procedures and their impact on POCD.

Summary:

• POCD is characterized by a lasting decrease in cognitive functions, particularly in elderly individuals post-surgery.
• Potential causes include anesthetic neurotoxicity affecting learning and memory, and neuroinflammation triggered by surgical stress.
• Maintaining perioperative physiological stability is considered the most critical preventive strategy for POCD.

Impact:

• This review underscores the need for further research into the multifactorial causes of POCD.
• It emphasizes the critical role of anesthetic management and perioperative care in mitigating cognitive risks for surgical patients.
• The findings highlight the current limitations in providing definitive recommendations on specific anesthesiological techniques to prevent POCD.