NYC Healthcare News



Special-focus on postoperative cognitive dysfunction in older adults

March 22, 2016

Meanwhile, Dr. Eckenoff suggests that it may be time to start informing patients of the possible risk of POCD before anesthesia. He writes, "A clear and consistent message needs to be understood and articulated by anesthesiologists during the consent process: altered cognitive states after surgery have been reported, and may last for weeks to months or longer." He calls for further research to identify the patients and procedures at highest risk of POCD, and what steps can be taken to reduce that risk.

In an opinion piece, Dr. Brendan Silbert and colleagues discuss the possible role of minimal cognitive impairment (MCI)??relatively mild reduction in intellectual functioning, thought to be an early stage of Alzheimer's disease. Since it's found in nearly seven percent of people over 65, many patients receiving anesthesia likely have MCI. At least some cases of persistent "POCD" in older adults may actually be a step in the process of MCI developing into Alzheimer's disease.

Dr. Silbert and coauthors suggest that anesthesiologists could play an active role in assessing cognitive function in older adults before surgery??just as they currently screen for heart disease risk factors. They write, "The anesthesiologist is ideally placed to contribute to both further research and clinical management of patients with both MCI and Alzheimer's disease."

Drs. Crosby and Culley hope the special focus section will stimulate new discussion and research into the brain's response to surgery, sedation, and general anesthesia. They conclude, "The specter of [POCD] is alarming to patients, families, and anesthesiologists alike, but it is also a strong motivator for learning more and doing better so that our work to heal the body does not harm the brain."

Source Anesthesia & Analgesia