Outcomes associated with postoperative cognitive dysfunction: a systematic review and meta-analysis

Age and Ageing, Journal Year: 2024, Volume and Issue: 53(7)

Published: July 1, 2024

Abstract Background Postoperative cognitive dysfunction (POCD) manifests as a subtle decline in cognition, potentially leading to unfavourable postoperative outcomes. We explored the impact of POCD on physical function, length hospital stay (LOS), dementia and mortality Methods PubMed Scopus were searched until May 2023. All studies major surgical patients that assessed outcomes interest included. effects stratified by surgery type (cardiac noncardiac) time assessment (<30 ≥30 days postsurgery). Results Of 2316 studies, 20 met inclusion criteria. was not associated with functional postsurgery. Patients who experienced postcardiac had an increased relative risk (RR) death 2.04 [(95% CI: 1.18, 3.50); I2 = 0.00%]. Sensitivity analyses showed associations intermediate-term among noncardiac patients, RR 1.84 1.26, 2.71); developed <30 surgeries longer LOS than those did [mean difference (MD) 1.37 (95% 0.35, 2.39); 92.38% MD 1.94 0.48, 3.40); 83.29%, respectively]. delirium (POD) may contribute heterogeneity observed, but limited data reported within Conclusions undergoing cardiac postsurgery poorer premature death. Early recognition perioperative neurocognitive disorders at-risk enable early intervention. However, POD confound our findings, further necessary disentangle from clinical

Language: Английский

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Clinical biomarkers of perioperative neurocognitive disorder: initiation and recommendation

Science China Life Sciences, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 22, 2025

Language: Английский

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Chronic Kidney Disease and Cognitive Dysfunction after Cardiac Surgery

Cardiovascular Innovations and Applications, Journal Year: 2025, Volume and Issue: 10(1)

Published: Jan. 1, 2025

Patients with chronic kidney disease (CKD) often encounter cardiovascular complications, most commonly coronary heart disease. Although artery bypass grafting is an effective treatment for this condition, many patients experience cognitive dysfunction after cardiac surgery. The complex interactions among functional status, general anesthesia, cardiopulmonary bypass, and surgical trauma in CKD elevate the risk of neurological issues increase mortality rates Consequently, both quality life overall prognosis are significantly affected. By reviewing recent research on postoperative CKD, we sought to clarify underlying mechanisms affecting population gain theoretical insights help decrease perioperative occurrence.

Language: Английский

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School Performance and Learning Challenges in Children and Adolescents with Congenital Heart Disease

Pediatric Cardiology, Journal Year: 2025, Volume and Issue: unknown

Published: March 24, 2025

Language: Английский

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Postoperative Delirium and Cognitive Dysfunction After Cardiac Surgery: The Role of Inflammation and Clinical Risk Factors

Diagnostics, Journal Year: 2025, Volume and Issue: 15(7), P. 844 - 844

Published: March 26, 2025

Background/Objectives: Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are prevalent neurological complications following cardiac surgery, significantly affecting patient recovery long-term outcomes, including increased risk of persistent impairment, functional decline, mortality. Understanding the underlying mechanisms factors for POD/POCD is crucial improving perioperative management. This study aimed to investigate relationship between systemic inflammation, assessed through inflammatory markers, occurrence POD POCD in patients undergoing surgery. Methods: We prospectively enrolled 88 aged 18-79 years open-heart Patients with preoperative impairment or high surgical (based on EuroSCORE SOFA scores) were excluded focus impact inflammation a relatively unselected cohort. responses (CRP, NLR, IL-6, IL-17A, SII, SIRI) measured, (CAM-ICU) (neuropsychological testing) during hospitalization at 3 months follow-up. Statistical comparisons performed who developed those did not. Results: was confirmed across cohort, significant increases CRP, SIRI. While correlational analyses changes individual markers not statistically entire exhibited higher levels IL-6 NLR 48 h postoperatively (p < 0.05). Established clinical associated included older age, prolonged cardiopulmonary bypass (CPB) duration, extended mechanical ventilation, vasopressor support blood transfusion, renal dysfunction, elevated creatine kinase (CK) lactate dehydrogenase (LDH) Ejection fraction (EF) 45% atrial fibrillation (AF) also more group. Conclusions: Our findings emphasize role response, particularly conjunction established factors, development after levels, readily measurable cost-effective may contribute identifying risk. Comprehensive management strategies targeting modifiable organ function mitigating outcomes this vulnerable population.

Language: Английский

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Effects of Midazolam and Dexmedetomidine on Cognitive Dysfunction Following Open‐Heart Surgery: A Comprehensive Review

Brain and Behavior, Journal Year: 2025, Volume and Issue: 15(4)

Published: April 1, 2025

ABSTRACT Purpose Patients undergoing open‐heart surgery often face significant challenges in postoperative cognitive dysfunction (POCD). There has been growing interest understanding how anesthesia medications, such as dexmedetomidine (DEX) and midazolam, impact function these patients. Method This comprehensive review aims to detail the effect of DEX midazolam on outcomes following surgery. Findings Midazolam, a highly selective commonly used benzodiazepine for preoperative anxiolytics sedation associated with POCD. However, evidence regarding its is vague; some studies suggest potential link between administration impairment, while others report no or even an improvement abilities. neuroprotective agent cardiac The effects function, including reduction POCD incidence severity, have reported several studies. It modulates inflammatory responses, attenuates oxidative stress, preserves cerebral perfusion. Although show promising results, their are yet be elucidated. Conclusion Various factors, patient characteristics, perioperative management, surgical procedures, may influence outcomes, highlighting need further research better understand roles agents

Language: Английский

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Mechanism of the Mongolian medicine Eerdun Wurile basic formula in improving postoperative cognitive dysfunction by inhibiting apoptosis through the SIRT1/p53 signaling pathway

Journal of Ethnopharmacology, Journal Year: 2023, Volume and Issue: 309, P. 116312 - 116312

Published: Feb. 28, 2023

The Mongolian medicine Eerdun Wurile is a commonly used in folk to treat cerebral nervous system diseases such as hemorrhage, thrombosis, nerve injury and cognitive function, cardiovascular hypertension coronary heart disease. wurile may effect anti-postoperative function.To investigate the molecular mechanism of Basic Formula (EWB) improving postoperative dysfunction (POCD) based on Network pharmacology, confirm involvement SIRT1/p53 signal pathway, one key pathways, by using POCD mouse model.Obtain compounds disease-related targets through TCMSP, TCMID, PubChem, PharmMapper platforms, GeneCards, OMIM databases, screen intersection genes; Use Cytoscape software build "drug-ingredient-disease-target" network, STRING platform for protein interaction analysis.; R was analyze function gene ontology (GO) Kyoto Encyclopedia Genes Genomes (KEGG) enrichment.; AutoDock Vina active components core Perform docking. model prepared intracerebroventricular injection lipopolysaccharide (LPS), morphological changes hippocampal tissue were observed hematoxylin-eosin (HE) staining, Western blot, immunofluorescence TUNEL verify results network pharmacological enrichment analysis.There 110 potential EWB, 117 items enriched GO, 113 pathways KEGG, among which signaling pathway related occurrence POCD. Quercetin, kaempferol, vestitol, β-sitosterol 7-methoxy-2-methyl isoflavone EWB can form stable conformations with low binding energy target proteins IL-6, CASP3, VEGFA, EGFR ESR1. Animal experiments showed that compared group, group could significantly improve apoptosis hippocampus mice, down-regulate expression Acetyl-p53 (P < 0.05).EWB characteristics multi-component, multi-target, multi-pathway synergistic effects. Studies have confirmed regulating genes provides new basis treatment

Language: Английский

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Development of a brief test protocol for assessing cognitive change in the peri‐operative period in older adults undergoing elective surgery

Anaesthesia, Journal Year: 2025, Volume and Issue: unknown

Published: March 24, 2025

Many patients are afraid of permanent cognitive impairment after general anaesthesia [1]. However, there is no uniform method to diagnose postoperative neurocognitive disorders extending beyond 1 month surgery [2]. The gold standard a time-consuming neuropsychological assessment [3]. We aimed identify and validate internally the best predictive subset tests, balancing accuracy utility suitable for both research clinical purposes. This study used data from previous After ethical approval informed consent, aged ≥ 65 y undergoing elective were enrolled. Patients with hearing impairment, multiple procedures under or pre-existent not studied. Neuropsychological was done pre-operatively 4–8 weeks postoperatively. It covered five domains, outcomes 17 individual subtests four combined scores (online Supporting Information Appendix S1). Outcomes reported in T-scores, corrected age educational level compared healthy Dutch patient group [4]. Missing imputed. Our definition based on composite domain scores, yielding an 18% incidence disorder as predictors would be results we defined this analysis decline SD two tests at least one domain, total score, aligning most [5]. checking multicollinearity, create logistic regression model S2). All delta test included, backward selection Akaike Criterion performed, using different cut-offs. When included middle last subtest test, deemed it necessary also include other (e.g. Stroop 1, 2 3). make protocol too time-consuming, selected lowest p values their subtests, while AUROC, so time administration acceptable. Internal validation bootstrapping, where AUROC coefficients uniformly measured optimism. Calibration assessed thresholds determined. Predictions made formula + e − β 0 * x … $$ \frac{1}{1+{e}^{-\left({\beta}_0+{\beta_1}^{\ast }x1+\dots \right)}} . Sensitivity specificity final tested against definition. Full statistical analyses can found online S3. In total, 77 had complete all baseline characteristics S4. diagnosed 32 (42%) disorder. approximately 30 min (Table 1). Therefore, three values, gave balance between AUROC. Digit Span Test (forward, sorting), (1, 2, 3), Auditory Verbal Learning approximate duration 20–24 yielded 0.91 (95%CI 0.83–0.98) before 0.86 0.77–0.97) internal Entering T-scores into predicted probability presence shown Fig. 1. Thresholds comparison S5. believe have identified short good properties providing promising alternative current assessment, which administered surgery. Interestingly, 42%, relatively high [6, 7]. might attributed inclusion cardiac study. again emphasises need corresponding diagnostic tool. Limitations small sample size led possible overfitting data, part conducted during COVID-19 pandemic may higher dropout rate cancelled our vulnerable population. does appear expression underlying frailty, dropouts did lower ASA physical status classifications. conclusion, extensive assessment. initially interest research, recommend future studies externally these results. Consensus precise recommended should generated multidisciplinary working group. authors like thank Rik van Eekelen, statistician, Amsterdam UMC, his advice development model. MvZ board member Association Anaesthesiology Data code will available upon reasonable request author. work supported by University Fund. No competing interests declared. S1. Composition S2. Correlations 21 Statistical methods. Baseline patients. battery per threshold disorders. Please note: publisher responsible content functionality any supporting information supplied authors. Any queries (other than missing content) directed author article.

Language: Английский

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Association between preoperative frailty and postoperative delirium and cognitive dysfunction in elderly patients undergoing surgery under general anaesthesia: A prospective observational study

Indian Journal of Anaesthesia, Journal Year: 2025, Volume and Issue: 69(6), P. 600 - 605

Published: May 14, 2025

Background and Aims: Advancing age is associated with poor physiological reserve to combat stressors of surgery anaesthesia, which termed frailty, it leads postoperative complications. Frailty has been found have a strong association delirium (POD) cognitive dysfunction (POCD) in cardiac surgeries. This study aims determine the frailty POD POCD patients undergoing non-cardiac Methods: A prospective observational, cohort was done at tertiary-level hospital on 130 aged 55 years above under general anaesthesia. Preoperative classified using 5-factor modified index (5mFI) sarcopenia [hand grip strength (HGS)]. were assessed revised Delirium Rating Scale (DRS) Addenbrooke’s Cognitive Examination-III 24 h, 72 h 30 days after surgery. Association between 5mFI HGS calculated linear regression model. Results: Of 117 analysed, 58% identified as frail (5mFI score ≥0.2), exhibiting 2.9 times higher risk [odds ratio (OR) 2.933, 95% confidence interval (CI): 1.001, 8.600, P = 0.050] 5.8 (OR: 5.380, CI: 1.718, 16.685, 0.004) compared non-frail counterparts. The correlation DRS-98 scores statistically significant ( < 0.001), indicating moderate positive association. However, sarcopenic displayed but insignificant incidence rates 1.967, 0.771, 5.014, 0.157) 1.070, 0.442, 2.589, 0.880) than non-sarcopenic patients. Patients >0.4 showed notably increased adverse events within post-surgery. Conclusions: Our proves hypothesis that apart from age, contributes POCD. Using predictor pre-anaesthetic checkups can help identify vulnerable early implement necessary interventions decrease burden decline.

Language: Английский

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The impact of postoperative cognitive training on health‐related quality of life and cognitive failures in daily living after heart valve surgery: A randomized clinical trial

Brain and Behavior, Journal Year: 2023, Volume and Issue: 13(3)

Published: Feb. 13, 2023

Abstract Background Heart surgery is a risk factor for objectively and subjectively assessable postoperative cognitive decline (POCD), which relevant everyday life. The aim of this study was to investigate whether early training has an impact on health‐related quality life failures in daily living after cardiac surgery. Methods two‐arm, randomized, controlled, outcome‐blinded trial involving older patients undergoing elective heart valve with extracorporeal circulation (ECC). Recruitment took place at the Departments Cardiac Surgery Kerckhoff Clinic Bad Nauheim (Germany) University Hospital Giessen (Germany). were randomized (1:1 ratio) either paper‐and‐pencil–based group or control group. We applied Short Form Health Survey (SF‐36) Cognitive Failures Questionnaire (CFQ) prior 3 months training. Data analyzed per‐protocol fashion. Results Three discharge from rehabilitation, ( n = 31) showed improvement compared 29), especially role limitations due emotional problems U −2.649, p .008, η 2 0.121), energy fatigue F [2.55] 5.72, .020, 0.062), social functioning −2.137, .033, 0.076), average all SF‐36 factors −2.374, .018, 0.094), health change past year present time −2.378, .017, mental component summary −2.470, .013, 0.102). Conclusion As our shown beneficial effects, intervention could be promising method enhance

Language: Английский

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