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Serum anticholinergic activity and postoperative cognitive dysfunction in elderly patients.

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Postoperative cognitive dysfunction (POCD) was not substantially linked to perioperative anticholinergic activity in elderly surgical patients. Further research is needed to explore other potential causes of POCD.

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Area of Science:

  • Anesthesiology
  • Geriatric Medicine
  • Neuroscience

Background:

  • Cerebral cholinergic transmission is vital for cognitive function.
  • Anticholinergic drugs are a potential cause of postoperative cognitive dysfunction (POCD).
  • Serum anticholinergic activity (SAA) may be associated with POCD in elderly patients.

Purpose of the Study:

  • To investigate the association between perioperative serum anticholinergic activity (SAA) and POCD in elderly patients undergoing major surgery.
  • To determine if increased SAA is a risk factor for developing POCD.

Main Methods:

  • Seventy-nine patients aged over 65 years undergoing elective major surgery were studied.
  • Cognitive functions were assessed preoperatively and 7 days postoperatively using the CERAD-Neuropsychological Assessment Battery.
  • POCD was defined as a decline >1 z-score in at least 2 cognitive tests; SAA was measured at both time points.

Main Results:

  • 46% of patients developed POCD; those with POCD were older and less educated.
  • No significant differences in preoperative, postoperative, or changes in SAA were found between patients with and without POCD.
  • No significant relationship was observed between changes in SAA and changes in cognitive function.

Conclusions:

  • In this cohort with low perioperative anticholinergic burden, POCD is likely not a substantial consequence of anticholinergic medications.
  • The findings suggest that other mechanisms are probably responsible for POCD in this patient group.
  • While a relationship cannot be entirely excluded, anticholinergic medications appear to play a minor role in POCD.