▎ WuXi AppTec content team editor
Surgery is becoming more common in older adults, but surgery can also be risky. Among them, postoperative cognitive decline (POCD) is a common risk that may occur in the elderly after surgery, mainly manifested by memory and attention impairment, which may be temporary or may last for months or even years.
Studies estimate that about one in ten older patients (60 years and older) may exhibit some degree of cognitive dysfunction within three months of surgery. At present, the diagnostic criteria for postoperative cognitive decline have not been standardized, and the causes and risk factors are also being explored.
Image credit: 123RF
A recent study shared at the annual meeting of the European Society of Anesthesiology and Critical Care (ESAIC) showed that long-term cognitive decline may be more severe in patients with high blood pressure, type 2 diabetes or less educated than in patients undergoing general anesthesia surgery.
Researchers from the Netherlands analyzed 1,823 participants with an average age of 51 who had normal cognitive function at the start of the study. To observe the participants' cognitive development, the researchers followed up the participants in years 6 and 12, and the researchers tested each participant during the follow-up. Each test includes a physical exam and a series of cognitive function tests. Cognitive function tests analyze participants' learning and memory, executive ability, information processing speed, and selective attention.
After modeling and analysis, it was found that compared with patients who had never undergone general anesthesia surgery, patients who had undergone more than 2 general anesthesia surgeries at the beginning of the study tended to be older and had other health conditions, such as hypertension, coronary artery disease, hypercholesterolemia, etc.
After adjusting for age, sex, education, smoking status, alcoholism, and other factors associated with the risk of cognitive decline, the researchers found that patients who had undergone at least 1 type of general anesthesia surgery were likely to perform worse on selective attention, execution, and selective attention tests than those who had never had surgery.
In addition, the researchers also found that although the number of general anesthetics did not appear to affect cognitive function and performance, long-term cognitive abilities were much more affected than general anesthesia surgery in patients with high blood pressure, hypercholesterolemia, type 2 diabetes, a history of smoking, or low levels of education.
Specifically, for patients with hypertension, hypercholesterolemia, and type 2 diabetes, their selective attention, mental speed, and information processing speed had a significant impact; for participants with lower levels of education, long-term cognitive abilities were significantly affected.
Lead author Dr Christoph Pennings of Maastricht University, the study's lead author, explains: "There are natural processes of cognitive decline throughout our lives, so after 12 years, almost everyone in the study will experience some form of cognitive decline. Different people have different ways and speeds, such as sudden, gradual, slow and gentle. ”
"Our study shows that patients who undergo more than one surgery under general anesthesia have little effect on long-term cognitive decline, but there are subtle impairments in information processing, selective attention, executive performance, and mental speed. Conversely, factors such as a history of hypertension, diabetes, and educational attainment seem to have a greater impact on the rate at which our cognitive abilities decline. ”
The authors also point out the study's limitations, including limited information on the time and type of surgery, limited specific information on the type and depth of anesthesia, and changes in surgical and anesthesia techniques over time, all of which may affect the results.