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Biomarkers and postoperative cognitive function: could it be that easy?

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Identifying reliable blood biomarkers for postoperative delirium (POD) and cognitive decline (POCD) in elderly patients remains challenging. While neuron-specific enolase shows promise, a combination of markers may be needed for accurate prediction.

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Area of Science:

  • Geriatric Medicine
  • Neuroscience
  • Anesthesiology

Background:

  • Postoperative cognitive dysfunction (POCD) and delirium (POD) are significant concerns in elderly surgical patients.
  • The multifactorial nature of POD/POCD complicates the identification of reliable predictive biomarkers.
  • Cerebrospinal fluid markers are difficult to obtain perioperatively, shifting focus to blood-based biomarkers.

Purpose of the Study:

  • To review recent literature on blood biomarkers for predicting and assessing postoperative delirium (POD) and postoperative cognitive decline (POCD).
  • To identify potential peripheral blood markers associated with neurocognitive dysfunction after surgery in the elderly.

Main Methods:

  • Literature review of studies investigating blood biomarkers for POD/POCD.
  • Categorization of identified markers into global/unspecific, specific/established, and emerging groups.
  • Evaluation of the evidence for neuron-specific enolase as a potential biomarker.

Main Results:

  • Peripheral blood markers are being explored as alternatives to cerebrospinal fluid.
  • Three categories of blood markers were identified: global, specific, and emerging.
  • Neuron-specific enolase is currently the most adequate single biomarker identified in recent literature.

Conclusions:

  • No single blood biomarker can reliably predict POD/POCD in geriatric patients.
  • A combination of promising biomarkers may offer improved sensitivity and specificity for preoperative assessment.
  • Further adequately powered studies are required to validate the utility of biomarker batteries.