Postoperative Cognitive Dysfunction (POCD) in Geriatric Patients

As the world population ages, the number of older patients undergoing surgery will increase significantly. Postoperative cognitive dysfunction (POCD) and other perioperative neurocognitive disorders (PND) affecting patients after surgery have long been recognized in older patients and are considered some of the most common postoperative complications. POCD has been correlated with significant morbidity and mortality, and greater healthcare costs. Historically, the lack of standardized nomenclature used to describe cognitive change after surgery and anesthesia has made it challenging to conduct systematic reviews or analyze the results of similar studies to further understand the clinical implications of this disorder. This has led to minimal recognition of this disorder outside of the specialty of anesthesiology. Patient and surgery-related risk factors include old age, preexisting cognitive changes, and emergency surgery amongst others. Proposed etiologies include postsurgical neuroinflammation, impairment of neurotransmitter systems, and cerebral vascular events in the perioperative period. The medical literature offers little guidance to recommend a particular anesthetic to decrease the risk of POCD in the postoperative patient. Most studies found similar risks of POCD after general and regional anesthesia techniques. While there is no standardized test for diagnosing preoperative cognitive impairment, it is critical to identify high-risk patients so that timely interventions can be made to minimize POCD.