Postoperative Cognitive Dysfunction and Delirium

Mark F. Newman, Miles Berger, Joseph P. Mathew

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

The brain is amazingly interesting and complex. As neuroscience progresses, we gain a broader understanding of specialized regional activity, chemistry and unique interconnections that makes us the fascinating and diverse organisms that we are. However, that same complexity makes assessment of brain function and injury causality difficult. A small embolic injury in the motor cortex results in substantial impact on one’s ability to move and function, while a much larger injury in silent areas of the cortex may go unnoticed. Furthermore, the brain is not static over the decades of life. In particular, the elderly are at increased risk of neurocognitive consequences of stress and injury due to reduced functional reserve. While the brain is amazingly complex on it’s own, it is not an isolated organ and our body’s broader response to stress or injury, including coagulation and inflammatory changes targeted toward a distant injury, may also impact the brain and the integrity of the connection between the brain and our body (the blood brain barrier). Finally, we add anesthesia and surgery into this complex mix of factors that can alter the ability to respond and function. This is particularly important, as anesthesia and surgery have progressed substantially in safety, such that older and sicker patients may now undergo increasingly complex procedures with low probability of morbidity and mortality. However, as previously noted the elderly are particularly susceptible to neurocognitive sequellae. The following chapter discusses our evolving understanding of postoperative cognitive dysfunction and delirium.

Original languageEnglish
Title of host publicationPerioperative Medicine
Subtitle of host publicationManaging for Outcome, Second Edition
Pages613-627
Number of pages15
ISBN (Electronic)9780323567244
DOIs
StatePublished - Jan 1 2021

Bibliographical note

Publisher Copyright:
© 2022 Elsevier Inc. All rights reserved.

Keywords

  • Etiology of POCD
  • Functionally connected brain networks
  • Inflammation
  • Perioperative Central Nervous System Injury
  • Postoperative Cognitive Decline (POCD)
  • Postoperative Delirium (POD)

ASJC Scopus subject areas

  • General Medicine

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