Perioperative neurocognitive disorder in non-cardicac surgery: A prospective single centre cohort trial

Aging is a complex process that reduces the body's functional reserve, with cognitive decline being its manifestation at the cerebral level. Cognitive impairment may worsen after surgery and anesthesia. The aim of this study is to describe the incidence of cognitive decline before and after surgery, as well as its associated factors in patients aged ≥65 years.

This is a prospective and contextual, study on perioperative cognitive decline, using a convenience sample in a university hospital in Spain. Preoperative cognitive evaluation was performed using the Mini-Mental State Examination (MMSE), the Digit Span Test (both forward and backward), the Free and Cued Selective Reminding Test (FCRST), the Trail Making Test A and B, and the Digit Symbol Substitution Test. Postoperative evaluation was conducted using the abbreviated IQCODE interview.

A total of 100 outpatients were studied (mean age 74.46 ± 6.49 yr). Forty-four patients (44%) had preoperative cognitive decline. Variables associated with preoperative cognitive decline included education level (OR 2.11), alcohol consumption (OR 3.37), Barthel Index (OR 2.29), and polypharmacy (OR 2.32), depression (OR 3.48), or COPD (OR 11.5). Following the IQCODE interview, 18% of patients exhibited postoperative cognitive decline.

Undiagnosed pre-existing cognitive dysfunction is very common in older patients awaiting surgery, and an important number experience worsening or new onset of cognitive decline following surgery.