This article reviews the recent clinical evidence published between January 2017 and June 2018 – related to perioperative cognitive evaluation. Namely, new insights into risk factors, prevention, diagnosis and diagnostic tools and treatment.
Several risk factors (preoperative, intraoperative and postoperative) have been found to be associated with the development of postoperative delirium (POD) and/or postoperative cognitive dysfunction (POCD). Short-term and long-term postoperative consequences can be reduced by targeting risk factors, introducing preventive strategies and including frequent cognitive monitoring. Administration of medications such as ketamine, opioids and benzodiazepines are associated with increased cognitive dysfunction. Prevention of POD/POCD starts with creating an environment, which promotes return to preoperative baseline functioning. This includes frequent monitoring of cognitive status, access to rehabilitation and psychological and social supports, and avoiding polypharmacy. In addition, patients should have early access to their sensory aids and maintain normal circadian rhythm. Treatment of POD/POCD has pharmacological and nonpharmacological approaches.
Clinical evidence on POD/POCD is continuously evolving, which is essential in guiding clinical management to provide the highest quality of clinical care.
aDepartment of Anaesthesiology and Intensive Care, First Moscow City Hospital named after N.I. Pirogov, Moscow, Russia
bDepartment of Anesthesiology, Critical Care and Pain Medicine, ‘Sapienza’ University, Rome, Italy
Correspondence to Federico Bilotta, MD, PhD, Department of Anesthesiology, Critical Care and Pain Medicine, ‘Sapienza’ University, Rome, Italy. Tel: +39 6 8608273; fax: +39 6 8608273; e-mail: firstname.lastname@example.org