Post-operative cognitive dysfunction after knee arthroplasty: a diagnostic dilemma.

Area of Science:

• Geriatric Medicine
• Neuroscience
• Anesthesiology

Background:

• Post-operative cognitive dysfunction (POCD) is a prevalent complication in elderly patients undergoing surgery, impacting recovery.
• Identifying the precise etiology of POCD remains a diagnostic challenge.

Observation:

• A 65-year-old male experienced acute cognitive dysfunction 4 weeks after total knee arthroplasty, lasting 19 days.
• No specific cause was found, but underlying factors included depression, mild memory deficits, and generalized brain volume loss.
• Psychogeriatric assessment suggested organic brain syndrome with superimposed depression, presenting as complex POCD.

Findings:

• The patient's behavioral disturbances escalated, necessitating antipsychotic and antidepressant treatment.
• Immediate positive response to psychotropic medication was observed.

Implications:

• Pre-operative cognitive assessment and risk factor evaluation are crucial for geriatric patients undergoing elective surgery.
• Further characterization of POCD and research into its underlying mechanisms are needed for improved identification and treatment.
• This case underscores the multifactorial nature of POCD and the importance of a comprehensive approach.