Postoperative Cognitive Dysfunction

Postoperative cognitive dysfunction is a condition in which cognitive impairment occurs after surgery and anesthesia, and is persistent beyond one month postoperatively. The condition is different from the transient confusion that may develop immediately following surgery and anesthesia (called postoperative delirium), or that may persist for a few days or weeks postoperatively (called delayed neurocognitive recovery).

Complications related to postoperative cognitive dysfunction include loss of function, decreased quality of life, and increased mortality.

Risk factors for postoperative cognitive dysfunction include postoperative delirium, older age, baseline cognitive impairment, a lower level of educational achievement, a history of stroke without any residual impairments, an abnormal brain MRI showing white matter disease and old silent strokes, a certain genetic variant in men (APOE4 carrier), and undergoing extensive surgery.

It is not uncommon for families to notice a person never quite seemed to recover after their surgery, and they regard the surgery and anesthesia as a significant turning point in the person’s cognitive and functional capabilities. Often, though, subtle symptoms are noted in retrospect to have been present prior to the surgery, but they had not risen to a level of concern that would have prompted a neurologic evaluation.

In a comprehensive evaluation, a person with postoperative cognitive dysfunction can be assessed for additional causes for their memory and cognitive decline, such as Alzheimer’s disease, vascular dementia, mixed dementia, or other types of dementia, which may have been present at an early stage prior to surgery and led to the increased risk for postoperative cognitive dysfunction. Once a person has specific diagnoses, they can be appropriately counseled on treatment options, safety and anticipatory guidance, prognosis, and strategies for optimizing brain health.

References and Resources

  1. Rundshagen, I. (2014). Postoperative cognitive dysfunction. Dtsch Arztebl Int, 111(8), 119-125. doi:10.3238/arztebl.2014.0119
  2. Mahanna-Gabrielli, E, Schenning, KJ, Eriksson, LI, Browndyke, JN, Wright, CB, Culley, DJ, Evered, L, Scott, DA, Wang, NY, Brown, CHt, Oh, E, Purdon, P, Inouye, S, Berger, M, Whittington, RA, Price, CC, & Deiner, S. (2019). State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018. Br J Anaesth, 123(4), 464-478. doi:10.1016/j.bja.2019.07.004

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