Perioperative neurocognition in elderly patients

Area of Science:

• Anesthesiology
• Neuroscience
• Gerontology

Background:

• Postoperative cognitive disturbance (POCD) is a significant concern in the perioperative period.
• Extrinsic risk factors contributing to POCD are controversial and require further investigation.

Purpose of the Study:

• To review recent studies on extrinsic risk factors for POCD.
• To analyze the impact of these factors during the perioperative period.

Main Methods:

• Review of recent scientific literature.
• Analysis of intraoperative factors and their association with cognitive outcomes.

Main Results:

• Impaired cerebral autoregulation can lead to intraoperative cerebral malperfusion, potentially causing POCD.
• Neurotoxicity of volatile anesthetics may contribute to cognitive decline; intravenous anesthesia's role needs more research.
• Multimodal analgesia may not be superior to traditional methods for preventing postoperative delirium.
• Pain, both acute and chronic, can worsen cognitive decline in patients with pre-existing impairment.
• The nuclear factor-kappa beta pathway is implicated in neuroinflammation.

Conclusions:

• Several intraoperative factors are linked to POCD.
• Optimizing perioperative management strategies can mitigate POCD and improve cognitive function.