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Published on: February 27, 2018
Postoperative Delirium and Postoperative Cognitive Dysfunction: Overlap and Divergence
Lori A Daiello1, Annie M Racine, Ray Yun Gou
1From the Alzheimer's Disease and Memory Disorders Center, Rhode Island Hospital, Providence, Rhode Island (L.A.D.) Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts (A.M.R., R.Y.G., S.K.I.) Harvard Medical School, Boston, Massachusetts (A.M.R., E.R.M., Z.X., L.J.K., K.V.V., S.K.I.) Departments of Medicine (E.R.M., S.K.I.) Anesthesia and Critical Care (L.J.K.), Beth Israel Deaconess Medical Center, Boston, Massachusetts Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts (Z.X.) Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts (K.V.V.) Departments of Psychiatry and Human Behavior (R.N.J.) Neurology (L.A.D., R.N.J.), Brown University Warren Alpert Medical School, Providence, Rhode Island.
Postoperative delirium increases the risk of postoperative cognitive dysfunction within the first month after surgery. However, this association diminishes over longer follow-up periods, suggesting distinct neurocognitive deficits.
Area of Science:
- Neuroscience
- Geriatric Medicine
- Anesthesiology
Background:
- Postoperative delirium and postoperative cognitive dysfunction share risk factors but their relationship is unclear.
- Understanding this relationship is crucial for managing perioperative neurocognitive disorders.
Purpose of the Study:
- To determine the prevalence of postoperative cognitive dysfunction.
- To investigate the association between in-hospital delirium and postoperative cognitive dysfunction.
Main Methods:
- Observational study using data from the Successful Aging after Elective Surgery study.
- Delirium assessed daily using Confusion Assessment Method; cognitive dysfunction evaluated using International Study of Postoperative Cognitive Dysfunction criteria.
- Associations examined at 1, 2, and 6 months post-surgery.
Main Results:
- 24% of participants developed delirium; 47% experienced cognitive dysfunction at 1 month, decreasing over time.
- Poor agreement and small correlations observed between delirium and cognitive dysfunction.
- Delirium elevated the risk of cognitive dysfunction at 1 month (RR=1.34) but not at 2 or 6 months.
Conclusions:
- Delirium significantly increases short-term postoperative cognitive dysfunction risk.
- The association between delirium and cognitive dysfunction is not sustained long-term.
- Postoperative delirium and cognitive dysfunction may represent distinct perioperative neurocognitive deficits.
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