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Sex differences and postoperative cognitive dysfunction: Unveiling biological mechanisms.

Sandra Regina Santana Aguiar Bonfante1, Khiany Mathias2, Taise Petronilho1

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Biological sex influences postoperative cognitive dysfunction (POCD) risk. This review explores how sex-based neuroinflammation and hormonal differences impact POCD, aiding targeted treatments for better patient outcomes.

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Area of Science:

  • Neuroscience
  • Gerontology
  • Immunology

Background:

  • Postoperative cognitive dysfunction (POCD) is a significant complication, especially in older adults, impacting recovery and quality of life.
  • Established POCD risk factors include age and prior cognitive conditions, but the role of biological sex is under-researched.
  • Emerging evidence suggests sex-based differences in brain structure, hormones, and neuroinflammation may affect POCD susceptibility.

Purpose of the Study:

  • To investigate the interaction between biological sex and neuroinflammation in the development of POCD.
  • To elucidate sex-based disparities in POCD incidence, progression, and pathogenesis.
  • To inform the development of sex-specific prevention and treatment strategies for POCD.

Main Methods:

  • This review synthesizes current literature on biological sex differences in neuroinflammatory responses.
  • It examines hormonal influences, such as estrogen's neuroprotective effects.
  • The review analyzes sex-specific genetic factors, like APOE4 allele carrier outcomes.

Main Results:

  • Women may exhibit increased vulnerability to inflammation-induced brain atrophy.
  • Estrogen may offer neuroprotection against surgical stress.
  • APOE4 allele carriers show sex-dependent postoperative cognitive outcomes, with males experiencing worse results.

Conclusions:

  • Biological sex is a critical, under-explored factor in POCD.
  • Sex-specific neuroinflammatory and hormonal pathways contribute to POCD pathogenesis.
  • Understanding these differences is essential for personalized POCD management and improved patient care.