Postoperative cognitive dysfunction: etiology, clinical features, diagnosis

Introduction. The present study analyzed the possibility of using neuropsychological tests to assess postoperative cognitive dysfunction. New data were obtained: in the postoperative period, hippocampal memory impairments predominate in patients, which makes it expedient to use methods for diagnosing primary modal-nonspecific memory disorders in patients who are to undergo neurosurgical intervention on the spinal cord.

The aim of the study to evaluate the influence of surgery with anesthesia on the cognitive functions of middle-age patients.

Materials and methods. The study included 20 middle-aged patients. All patients had to undergo spinal surgery. Patients received total intravenous anesthesia with propofol induction (4–12 mg/kg/hr). Cognitive functions before and after the operation were made with the use of the MoCA, TMT A and B, FCSRT, state-trait anxiety inventory test (STAI).

Results. The development of POCD was noted in 15% of cases. The patients showed a decrease in the FCSRT prompt index (1st day = 87 ± 9.0; 2nd day = 83 ± 15; p = 0,0005), while the overall severity of cognitive impairments (total score of MoCA) did not change significantly (standard deviation according to MoCA: 24.25 ± 2.86 on day 1 and 24 ± 3.24 on the second day, p = 0.61). The RT level decreased by day 2: 44.65 ± 7.4 versus 41.1 ± 8.2 (p = 0.001). Correlation analysis did not show the relationship between the age of patients, education level, comorbidity and development of POCD; however, the duration of anesthesia was associated with a decrease in MoCA scores (Pearson’s correlation coefficient r = –0.44; p = 0.050).

Conclusion. Thus, our study shows that the study of hippocampal memory impairments is important in patients with POCD. These data differ from the data of researchers presented earlier, where the most important clinical manifestations of POCD are considered to be a decrease in attention and speed of mental processes. Of course, the small sample size dictates the need for additional research.

1. Zarbo C., Brivio M., Brugnera A., Malandrino C., Trezzi G., Rabboni M. et al. Postoperative cognitive decline (POCD) after gynaecologic surgery: current opinions and future applications. Arch Gynecol Obstet. 2018;297(3):551–554. https://doi.org/10.1007/s00404-017-4630-3.

2. Pan C.-W., Wang X., Ma Q., Sun H.-P., Xu Y., Wang P. Cognitive dysfunction and health-related quality of life among older Chinese. Sci Rep. 2015;5:17301. https://doi.org/10.1038/srep17301.

3. Berger M., Nadler J.W., Browndyke J., Terrando N., Ponnusamy V., Cohen H.J. et al. Postoperative Cognitive Dysfunction: Minding the Gaps in Our Knowledge of a Common Postoperative Complication in the Elderly. Anesthesiol Clin. 2015;33(3):517–550. https://doi.org/10.1016/j.anclin.2015.05.008.

4. Price C.C., Garvan C.W., Monk T.G. Type and severity of cognitive decline in older adults after noncardiac surgery. Anesthesiology. 2008;108(1):8–17. https://doi.org/10.1097/01.anes.0000296072.02527.18.

5. Monk T.G., Weldon B.C., Garvan C.W., Dede D.E., van der Aa M.T., Heilman K.M., Gravenstein J.S. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108(1): 18-30. https://doi.org/10.1097/01.anes.0000296071.19434.1e.

6. Evered L., Scott D.A., Silbert B., Maruff P. Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesth Analg. 2011;112(5):1179–1185. https://doi.org/10.1213/ANE.0b013e318215217e.

7. Harten van A. E., Scheeren T.W., Absalom A.R. A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anesthesia. Anesthesia. 2012;67(3): 280-293. https://doi.org/10.1111/j.1365-2044.2011.07008.x.

8. Kapasi A., Leurgans S.E., James B.D., Boule P.A., Arvanitakis Z., Naget S. et al. Watershed microinfarct pathology and cognition in older persons. Neurobiol Aging. 2018;70:10–17. https://doi.org/10.1016/j.neurobiolaging.2018.05.027.

9. Xu J.-H., Zhang T.-Z., Peng X.-F., Jin C.-J., Zhou J., Zhang Y.-N. Effects of sevoflurane before cardiopulmonary bypass on cerebral oxygen balance and early postoperative cognitive dysfunction. Neurol Sci. 2013;34(12):2123–2129. https://doi.org/10.1007/s10072-013-1347-3.

10. Ji M.-H., Yuan H.-M., Zhang G.-F., Xiao-Min Li, Dong L., Li W.-Y. et al: Changes in plasma and cerebrospinal fluid biomarkers in aged patients with early postoperative cognitive dysfunction following total hip-replacement surgery. J Anesth. 2013;27(2):236–242. https://doi.org/10.1007/s00540-012-1506-3.

11. Lili X., Zhiyong H., Jianjun S. A preliminary study of the effects of ulinastatin on early postoperative cognition function in patients undergoing abdominal surgery. Neurosci Lett. 2013;541:15–19. https://doi.org/10.1016/j.neulet.2013.02.008.

12. Tang Y., Ouyang W. [Inflammation-relevant mechanisms for postoperative cognitive dysfunction and the preventive strategy]. Zhong Nan Da Xue Bao Yi Xue Ban. 2017;42(11):1321–1326. https://doi.org/10.11817/j.issn.1672-7347.2017.11.013.

13. Riedel B., Browne K., Silbert B. Cerebral protection: inflammation, endothelial dysfunction, and postoperative cognitive dysfunction. Curr Opin Anesthesiol. 2014;27(1):89–97. https://doi.org/10.1097/ACO.0000000000000032.

14. Lu S.-M., Yu C.-J., Liu Y.-H., Dong H.-Q., Zhang X., Zhang S.-S. et al. S100A8 contributes to postoperative cognitive dysfunction in mice undergoing tibial fracture surgery by activating the TLR4/MyD88 pathway. Brain Behav Immun. 2015;44:221–234. https://doi.org/10.1016/j.bbi.2014.10.011.

15. Li J., Wei P., Zheng Q., Zhou J., Li J. Neuroprotective effects of intravenous lidocaine on early postoperative cognitive dysfunction in elderly patients following spine surgery. Med Sci Monit. 2015;21:1402–1407. https://doi.org/10.12659/MSM.894384.

16. Schoen J., Husemann L., Tiemeyer C., Lueloh A., Sedemund-Adib B., Berger K.-U. et al. Cognitive function after sevoflurane- vs propofol-based anesthesia for on-pump cardiac surgery: a randomized controlled trial. Brit J Anesthesia. 2011;106(6):840–850. https://doi.org/10.1093/bja/aer091.

17. Royse C.F., Andrews D.T., Newman S.N., Stygall J., Williams Z., Pang J., Royse A.G. The influence of propofol or desflurane on postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery. Anesthesia. 2011;66(6):455–464. https://doi.org/10.1111/j.1365-2044.2011.06704.x.

18. Moller J.T., Cluitmans P., Rasmussen L.S., Houx P., Rasmussen H., Canet J. et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of PostOperative Cognitive Dysfunction. Lancet. 1998;351(9106):857–861. https://doi.org/10.1016/s0140-6736(97)07382-0.

19. Turnbull I.R., Wlzorek J.J., Osborne D., Hotchkiss R.S., Coopersmith C.M., Buchman T.G. Effects of age on mortality and antibiotic efficacy in cecal ligation and puncture. Shock. 2003;19(4):310–313. https://doi.org/10.1097/00024382-200304000-00003.

20. Steinmetz J., Christensen K.B., Lund T., Lohse N., Rasmussen L.S. long-term consequences of postoperative cognitive dysfunction. Anesthesiology. 2009;110(3):548–555. https://doi.org/10.1097/ALN.0b013e318195b569.

21. Xu T., Bo L., Wang J., Zhao Z., Xu Z., Deng X., Zhu W. Risk factors for early postoperative cognitive dysfunction after non-coronary bypass surgery in Chinese population. J Cardiothorac Surg. 2013;8:204. https://doi.org/10.1186/1749-8090-8-204.

22. Kim J., Shim J. K, Song J.W., Kim E.K., Kwak Y.L. Postoperative Cognitive Dysfunction and the Change of Regional Cerebral Oxygen Saturation in Elderly Patients Undergoing Spinal Surgery. Anesth Analg. 2016;123(2):436–444. https://doi.org/10.1213/ANE.0000000000001352.

23. Czyż-Szypenbejl K., Mędrzycka-Dąbrowska W., Kwiecień-Jaguś K., Lewandowska K. The Occurrence of Postoperative Cognitive Dysfunction (POCD) – Systematic Review. Psychiatr Pol. 2019;53(1):145–160. https://doi.org/10.12740/PP/90648.

24. Nasreddine Z.S., Phillips N.A., Bédirian V., Charbonneau S., Whitehead V., Collin I. et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x.

25. Cibelli M., Fidalgo A.R., Terrando N., Ma D., Monaco Cl., Feldmann M. et al. Role of Interleukin-1β in Postoperative Cognitive Dysfunction. Ann Neurol. 2010;68(3):360–368. https://doi.org/10.1002/ana.22082.

26. Rundshagen I. Postoperative cognitive dysfunction. Dtsch Arztebl Int. 2014;111(8):119–125. https://doi.org/10.3238/arztebl.2014.0119.

27. Lee J.J., Choi G.J., Kang H., Baek C.W., Jung Y.H., Shin H.Y. et al. Relationship between Surgery under General Anesthesia and the Development of Dementia: A Systematic Review and Meta-Analysis. Biomed Res Int. 2020;2020:3234013. https://doi.org/10.1155/2020/3234013.

28. Kline R., Wong E., Haile M., Didehvar S., Farber S., Sacks A. et al. Perioperative Inflammatory Cytokines in Plasma of the Elderly Correlate in Prospective Study with Postoperative Changes in Cognitive Test Scores. Int J Anesthesiol Res. 2016;4(8):313–321. Available at: https://pubmed.ncbi.nlm.nih.gov/28317003.

29. Scott J.E., Mathias J.L., Kneebone A.C., Krishnan J. Postoperative cognitive dysfunction and its relationship to cognitive reserve in elderly total joint replacement patients. J Clin Exp Neuropsychol. 2017;39(5):459–472. https://doi.org/10.1080/13803395.2016.1233940.

30. Polunina A.G., Golukhova E.Z., Guekht A.B., Lefterova N.P., Bokeria L.A. Cognitive Dysfunction after On-Pump Operations: Neuropsychological Characteristics and Optimal Core Battery of Tests. Stroke Res Treat. 2014;2014:302824. https://doi.org/10.1155/2014/302824.

31. Xu H., Fu G., Wu G. Effect of dexmedetomidine-induced anesthesia on the postoperative cognitive function of elder patients after laparoscopic ovarian cystectomy. Saudi J Biol Sci. 2017;24(8):1771–1775. https://doi.org/10.1016/j.sjbs.2017.11.010.

32. Chi Y.-L., Li Z.-S., Lin C.-S., Wang Q., Zhou Y.-K. Evaluation of the postoperative cognitive dysfunction in elderly patients with general anesthesia. Eur Rev Med Pharmacol Sci. 2017;21(6):1346–1354. Available at: https://pubmed.ncbi.nlm.nih.gov/28387891.