Pathogenesis and treatment of post-operative cognitive dysfunction.

Area of Science:

• Neurology
• Geriatrics
• Anesthesiology

Background:

• Post-operative cognitive dysfunction (POCD) and post-operative delirium (POD) are common cognitive disorders following surgery.
• POCD is not recognized as a distinct entity in the DSM, leading to limited understanding of its pathogenesis.
• Elderly patients are more susceptible to developing POCD, typically manifesting over weeks to months after surgery.

Purpose of the Study:

• To review and synthesize current knowledge on the pathogenesis mechanisms of POCD.
• To highlight key data regarding the treatment strategies for POCD.
• To differentiate POCD from other post-operative cognitive impairments, primarily delirium.

Main Methods:

• A comprehensive literature review was conducted from March to June 2015.
• Bibliographic databases including PubMed, Google Scholar, and SCOPUS were searched for articles published from 1955 to 2014.
• Emphasis was placed on studies from the last fifteen years, with inclusion of seminal earlier works.

Main Results:

• POCD is characterized by deficits in attention, concentration, memory, and psychomotor speed.
• Proposed pathogenic mechanisms include hyperventilation, hypotension, cerebral microemboli, and inflammatory responses.
• Differential diagnosis primarily involves distinguishing POCD from delirium.

Conclusions:

• Understanding the pathogenesis of POCD is crucial due to its prevalence and impact, especially in the elderly.
• Treatment involves ruling out other organic psychosyndromes and addressing specific POCD symptoms.
• Further research is needed to fully elucidate POCD mechanisms and optimize management strategies.