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Postoperative cognitive dysfunction - current preventive strategies.
Nalini Kotekar1, Anshul Shenkar2, Ravishankar Nagaraj3
1Department of Anaesthesiology, JSS Academy of Higher Education and Research, Mysore, Karnataka, India, nalinikotekar@gmail.com.
Clinical Interventions in Aging
|December 7, 2018
Summary
Elderly patients undergoing surgery face risks of postoperative cognitive dysfunction (POCD). Comprehensive geriatric assessments and Enhanced Recovery After Surgery protocols can help prevent and manage this condition.
Area of Science:
- Geriatric Medicine
- Anesthesiology
- Neuroscience
Background:
- Global healthcare improvements lead to a growing elderly population.
- Older patients, often with comorbidities, undergo surgery more frequently.
- Postoperative cognitive dysfunction (POCD) affects a significant percentage of elderly surgical patients.
Purpose of the Study:
- To review strategies for preventing and managing postoperative cognitive dysfunction (POCD) in the elderly.
- To highlight the role of comprehensive geriatric assessment and Enhanced Recovery After Surgery (ERAS).
- To discuss current and emerging therapeutic interventions for POCD.
Main Methods:
- Review of current literature on geriatric care, surgical outcomes, and cognitive dysfunction.
- Analysis of risk factors contributing to POCD, including age, comorbidities, and pre-existing mental health.
- Evaluation of preventive strategies like comprehensive geriatric assessment and ERAS protocols.
Main Results:
- Comprehensive geriatric assessment aids in preoperative optimization for elderly patients.
- Enhanced Recovery After Surgery (ERAS) protocols, including care bundles, improve perioperative outcomes.
- Research into biomarkers for neural injury in POCD is advancing, with potential roles for acetylcholine esterase inhibitors and anti-inflammatory interventions.
Conclusions:
- Preventive strategies, early recognition, and management of perioperative risk factors are crucial for addressing POCD.
- While pharmacologic and anti-oxidative interventions show promise, they currently have limitations.
- A multi-faceted approach focusing on preoperative optimization and stress-free surgical environments is the most effective current strategy against POCD.