Epidemiology, Mechanisms and Consequences of Postoperative Cognitive Dysfunction

Abstract

This chapter provides an overview of the spectrum of disorders that can be understood as post operative cognitive dysfunction (POCD). It links to other chapters in this book and highlights the difficulties of confirming clear links between the provision of anaesthesia and the development of POCD, partly because POCD is a condition without a clear definition which makes diagnosis and comparison between studies problematic.

Despite this, development of POCD is troubling for patients and their families and deserves more attention as the population becomes frailer and older and the incidence of POCD is expected to increase. Although plausible biological models exist for changes to brain neurons in the perioperative period, POCD is still thought to be largely reversible and not clearly linked to the subsequent development of dementia. However difficulties in consistently testing neurocognitive function indicate these assumptions are not definitely correct.

More emphasis needs to be placed on preoperative assessment of neurocognitive function and risk factor identification. A multidisciplinary care bundle approach to risk factor stratification and reduction based on evidence of slight benefit from individual interventions is all we can offer to modify risk along with an anaesthetic technique that is deemed most appropriate for the patient and safest in that individual anaesthetist’s hands.