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Brain Structural and Functional Changes Associated With Postoperative Neurocognitive Disorders: Research Update.

Huimin Wu1,2, Yaseen Ahammed3, Shouyuan Tian1

  • 1From the Department of Anesthesiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi Province, China.

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Postoperative neurocognitive disorders (PNDs) are common in elderly patients after surgery. This review explores PND risk factors, mechanisms, and the use of brain monitoring techniques to improve patient outcomes.

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Area of Science:

  • Neuroscience
  • Geriatric Medicine
  • Anesthesiology

Background:

  • Postoperative neurocognitive disorders (PNDs) are significant complications in elderly patients, increasing morbidity, mortality, and healthcare costs.
  • The exact causes of PNDs remain unclear, but factors like surgical stress and inflammation leading to neuroinflammation are implicated.
  • Perioperative neurological monitoring in elderly individuals can offer insights into brain function and aid in early intervention.

Purpose of the Study:

  • To review the known risk factors and potential mechanisms contributing to PNDs.
  • To discuss the preliminary evidence for using various neuroimaging techniques for monitoring elderly patients during the perioperative period.

Main Methods:

  • Literature review summarizing current understanding of PND pathogenesis.
  • Discussion of neuroimaging modalities including electroencephalography (EEG), functional near-infrared spectroscopy (fNIRS), functional magnetic resonance imaging (fMRI), and positron emission tomography (PET).

Main Results:

  • PNDs are linked to systemic inflammation, neuroinflammation, and subsequent brain changes.
  • Several monitoring techniques show potential for assessing central nervous system status during the perioperative phase.
  • Early identification of risks through monitoring may lead to improved patient safety and prognosis.

Conclusions:

  • Understanding PND risk factors and mechanisms is crucial for developing effective prevention and treatment strategies.
  • Neurophysiological and neuroimaging monitoring techniques offer promising avenues for real-time assessment of brain function in elderly surgical patients.
  • Further research is needed to validate these monitoring tools for routine clinical application in PND management.