Risk factors for postoperative cognitive dysfunction in elderly patients undergoing surgery for oral malignancies

This study aimed to investigate the potential risk factors for postoperative cognitive dysfunction (POCD) in elderly patients with gastric cancer (GC) after radical gastrectomy. In total, 221 elderly patients with GC who were scheduled to undergo selective radical gastrectomy in our hospital were enrolled in this study. To define early POCD, the neuropsychological assessment was carried out 1 day before surgery and 7 days after surgery. Receiver operating characteristic curve analysis was carried out to evaluate the predicative and cut-off values of risk factors, including neutrophil-lymphocyte ratio (NLR) for early POCD. The univariate and multivariate logistic regression analyses were performed to investigate risk factors for early POCD. Of the 221 enrolled elderly patients with GC, 42 were identified as early POCD with an incidence of 19.0% (42 of 221). Receiver operating characteristic curve analysis indicated that NLR was a significant predictor for POCD with a cut-off value of 2.50 and an area under the curve of 0.711 (95% confidence interval: 0.624-0.798, P < 0.001). Preoperative NLR (≥2.50) was the only independent risk factor associated with POCD (odds ratio: 2.44, 95% confidence interval: 1.52-3.68, P = 0.013) by the multivariate logistic regression analysis. Preoperative NLR level was an independent risk factor for POCD in elderly patients with GC undergoing curative resection. Geriatr Gerontol Int 2020; 20: 927-931.

Early identification of elderly patients undergoing non-cardiac surgery who may be at high risk for postoperative cognitive dysfunction (POCD) can increase the chances of prevention for them, as extra attention and limited resources can be allocated more to these patients. We performed this analysis with the aim of developing a simple, clinically useful machine learning (ML) model to predict the probability of POCD at 3months in elderly patients after non-cardiac surgery. We collected information on patients who received surgical treatment at Nanjing First Hospital from May 2020 to May 2021. We used LASSO regression to select key features and built 5 ML models to assess the risk of POCD at 3months in elderly patients after non-cardiac surgery. The Shapley Additive exPlanations (SHAP) and methods were introduced to interpret the best model. A total of 415 patients with non-cardiac surgery were included. The support vector machine (SVM) was the best-performing model of the five ML models. The model showed excellent performance compared to the other four models. The SHAP results showed that VAS score, age, intraoperative hypotension, and preoperative hemoglobin were the four most important features, indicating that the SVM model had good interpretability and reliability. The website of the web-based calculator was https://modricreagan-non-3-pocd-9w2q78.streamlit.app/ . Based on six important perioperative variables, we successfully established a series of ML models for predicting POCD occurrence at 3months after surgery in elderly non-cardiac patients, with SVM model being the best-performing model. Our models are expected to serve as decision aids for clinicians to monitor screened high-risk patients more closely or to consider further interventions.

Background: : Improvements in global life expectancy have led to a significant increase in the elderly population, which in turn results in a growing number of elderly patients undergoing surgery. This condition raises the risk of postoperative complications, such as postoperative cognitive dysfunction (POCD). POCD can reduce quality of life, prolong the length of hospital stay, and increase mortality. This study aims to identify and synthesize the factors that influence the occurrence of POCD in elderly patients. Subjects and Method: This study is a Systematic review with PICO. The article used in research were obtained from several databased including Google Scolar, Scopus, and PubMed Keywords to find articles are "postoperative cognitive dysfunction," "elderly patients," and "geriatrics". This articles used are failing to directly discuss risk factors for postoperative cognitive dysfunction in elderly patients, or identified as opinion pieces, conference abstracts without full text, or narrative reviews, will be excluded. Articles were selected using PRISMA flow diagram. Results: a total 8 articles reviewed in Systematic Review showed that The incidence of POCD in the elderly shows significant variation between studies, ranging from 8.33% to 37.7% . Risk factors that have been consistently identified as having a significant influence on the incidence of POCD include advancing age, low level of education, number of comorbidities, high ASA score, long duration of anesthesia, intraoperative hypotension, history of cerebral infarction, and low oxygen saturation at induction. The use of certain anesthetic agents such as sevoflurane and midazolam has also been shown to increase the risk of POCD. Instead, use dexmedetomidine preoperative, analgesia preemptive and the combination of general anesthesia with epidural block were identified as protective factors. Conclusion: The main risk factors advanced age, education level, comorbidities, and type and duration of anesthesia.

Objective To investigate the risk factors for early postoperative cognitive dysfunction (POCD) in elderly patients after colorectal cancer surgery.Methods One hunderd and twenty ASA Ⅱ or Ⅲ patients aged ≥ 65 yr undergoing colorectal cancer surgery were divided into POCD group and non-POCD group according to the results of the Mini-Mental State examination (MMSE) at 7th day after operation.Age,weight,sex,the educational level,anatomical location of the tumor,TNM stages,complications,preoperative TCM syndrome type,duration of anesthesia,emergence time,the blood loss during opertion and the number of intraoperative hypotension were recorded.The cognitive function was assessed at 1 d before operation and at 1,3,7 d after operation using MMSE.The risk factors for POCD were analyzed by multivariate logistic regression analysis.Results The incidence of POCD was 29.2 ％.Logistic regression analysis results indicated that age,the educational level,anatomical location of the tumor and the number of intraoperative hypotension were the risk factors for POCD( P ＜ 0.05).Conclusion Age,the educational level,anatomical location of the tumor and the number of intraoperative hypotension are risk factors for POCD in elderly patients after colorectal cancer surgery. Key words: Aged; Cognition disorders; Intestinal neoplasms; Risk factors

Objective To evaluate the effect of perioperative continuous femoral nerve block on postoperative cognitive dysfunction(POCD)in elderly patients with femoral neck fractures. Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 65-90 yr, scheduled for femoral head replacement under combined spinal-epidural anesthesia, were divided into 2 groups(n=30 each)using a random number table: patient-controlled femoral nerve block for analgesia(PCNA)group and patient-controlled intravenous analgesia(PCIA)group.When the patients were diagnosed with femoral neck fractures after admission to hospital in two groups, patients received continuous PCNA under nerve stimulator guidance until 48 h after operation in group PCNA, and fentanyl was continuously injected for analgesia until 48 h after operation in group PCIA.Neuraxial anesthesia was performed at L3, 4 interspace, 2 ml cerebrospinal fluid was extracted after successful subarachnoid puncture to detect the concentrations of Aβ-42 and tau, and the ratio of Aβ-42 to tau was calculated.The patient′s cognitive function was assessed using Mini-Mental State Examination before analgesia and at 7 days after operation, and the occurrence of POCD was recorded. Results The ratio of Aβ-42 to tau in cerebrospinal fluid was significantly lower, and the incidence of POCD was higher at 7 days after operation in group PCIA than in group PCNA(P<0.05). Conclusion Perioperative continuous femoral nerve block can decrease the development of POCD in elderly patients with femoral neck fractures. Key words: Nerve block; Femoral nerve; Cognition disorders; Aged

To investigate the impact of goal-directed fluid therapy (GDFT) on postoperative cognitive dysfunction (POCD) in elderly patients with colorectal cancer, we conducted a randomized controlled trial. Eighty elderly patients who underwent elective laparoscopic radical resection of colorectal cancer were randomly assigned to either the GDFT group or the conventional fluid therapy group. The primary outcome was the incidence of POCD during the initial 7 postoperative days, while secondary outcomes included inflammatory marker levels such as interleukin-6 (IL-6) and S100β protein, hemodynamics, level of lactic acid, postoperative functional recovery, and complications. Among 88 randomized patients, 80 were evaluable for the primary outcome. The incidence of POCD was significantly lower in the GDFT group (15.0%) compared to the conventional fluid therapy group (30.0%), with the highest occurrence observed on day 3 postoperatively in both groups (P < 0.05). IL-6 and S100β concentrations were consistently lower in the GDFT group than in the conventional fluid therapy group at the corresponding time points (P < 0.05). The GDFT group exhibited more stable perioperative hemodynamics and lower lactate levels (P < 0.05). Moreover, patients in the GDFT group exhibited better postoperative functional recovery indicators and a lower incidence of postoperative complications (P < 0.05). In summary, GDFT appears to reduce the incidence of early POCD, accelerate postoperative recovery, and enhance overall prognosis.

Post-operative cognitive dysfunction is associated with morbidity and mortality. However, its neuropathogenesis remains largely to be determined. Neuroinflammation and accumulation of β-amyloid (Aβ) have been reported to contribute to cognitive dysfunction in humans and cognitive impairment in animals. Our recent studies have established a pre-clinical model in mice, and have found that the peripheral surgical wounding without the influence of general anesthesia induces an age-dependent Aβ accumulation and cognitive impairment in mice. We therefore set out to assess the effects of peripheral surgical wounding, in the absence of general anesthesia, on neuroinflammation in mice with different ages. Abdominal surgery under local anesthesia was established in 9 and 18 month-old mice. The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), Iba1 positive cells (the marker of microglia activation), CD33, and cognitive function in mice were determined. The peripheral surgical wounding increased the levels of TNF-α, IL-6, and Iba1 positive cells in the hippocampus of both 9 and 18 month-old mice, and age potentiated these effects. The peripheral surgical wounding increased the levels of CD33 in the hippocampus of 18, but not 9, month-old mice. Finally, anti-inflammatory drug ibuprofen ameliorated the peripheral surgical wounding-induced cognitive impairment in 18 month-old mice. These data suggested that the peripheral surgical wounding could induce an age-dependent neuroinflammation and elevation of CD33 levels in the hippocampus of mice, which could lead to cognitive impairment in aged mice. Pending further studies, anti-inflammatory therapies may reduce the risk of postoperative cognitive dysfunction in elderly patients.

Effects of cerebral oxygen changes during coronary bypass surgery on postoperative cognitive dysfunction in elderly patients: a pilot study

Objective To discuss the correlation of perioperative brain function state quantitative monitoring results with postoperative cognitive dysfunction (POCD) in elderly patients. Methods The clinical data of 200 patients with lumbar spinal decompression fusion surgery were analyzed retrospectively. They were divided into the POCD group (134 patients) and the non POCD group (66 patients) by Z count scores. The results of test indexes including wavelet index (WLI), concentration index (i_22) and brain activity index (i_20) were compared. Results Perioperative elderly patients Brain function characteristics analysis results of perioperative elderly patients showed that the level of WLI at postoperative day 7(96.24 ± 2.41)was higher than that at preoperative day 1(98.76 ± 2.65) and postoperative day 3(98.68 ± 3.01), and there were significant differences (t =4.475, 4.475, P =0.000, 0.000). The level of i_22 at preoperative day 1, postoperative day 3 and postoperative day 7 had no significant difference (F =7.365, P =0.075). The level of i_20 at preoperative day 1, postoperative day 3 and postoperative day 7 had no significant difference (F =6.663, P =0.068). At preoperative day 1, the level of i_22 in POCD group was significantly lower than that in non POCD group(t =15.875, P =0.000). Conclusions Brain function index of perioperative elderly patients has certain characteristics in different time points, and i_22 may could be considered as a judge index of POCD. Key words: Postoperative cognitive dysfunction; Brain function state quantitative; Perioperative period

Objective To compare basic cognitive capability teat (version 2.0) with the method recommended by ISPOCD (international study of postoperative cognitive dysfunction) on the evaluation of postoperative cognitive dysfunction (POCD) in elderly patients, and study the correlation of two different methods. Methods Two neuropsychological tests were performed preoperatively, and postoperatively on Day 7 and 3 months upon 131 elderly patients undergoing elective major non-cardiac surgery and 30 healthy elderly volunteers that were set as a control group. One was Basic Cognitive Capability Test (Method A), including digit copying (A1), mental arithmetic (A3), et al. However, The other was recommended by ISPOCD (Method B), including trail making test (B1), digit symbol sub-test (B2), et al. Z score was used to analyze the data. POCD was defined as Z score ≥2. Results (1) 120 out of 131 patients had completed the tests on Day 7 postoperatively, and then 67 among them had finished the tests 3 months postoperatively. (2) The incidence rate of POCD on Day 7 was (12.5% and 10.8%,P>0.05); and at 3 months was (5.97% and 7.46%, P >0.05). (3) Two methods were consistent for evaluation of POCD on Day 7 and 3 months postoperatively. Kappa were 0. 758 and 0.881, P<0.05. (4) Both on Day 7 and 3 months, the combined Z score of Method A and Method B had significant correlation, r =0.316 and 0.302 ,P < 0.05. (5) As for speed of recognition, digit copying (A1) vs. trail making test (B1) had significant correlation, r=0.517, P<0.05. For ability of study and performance, mental arithmetic (A3) vs. digit symbol subtest (B2) had significant correlation, r = 0. 52, P < 0. 05. Conclusion Basic cognitive capability test was consistent with tests recommended by ISPOCD for evaluation of POCD. Basic cognitive capability test using computer was more objective, accurate and beneficial for clinical practice. Key words: POCD; Basic cognitive capability test; Neuropsychological tests

Transcutaneous vagus nerve stimulation may attenuate postoperative cognitive dysfunction in elderly patients

Effect of parecoxib sodium pretreatment combined with dexmedetomidine on early postoperative cognitive dysfunction in elderly patients after shoulder arthroscopy: A randomized double blinded controlled trial

Objective Elderly patients with hip surgery are prone to postoperative cognitive dysfunction (POCD), leading to health management difficulties. This study is aimed at investigating the effect of ultrasound radiomics-guided iliac fascia block on POCD. Methods A total of 67 cases of patients who had undergone hip joint surgery were divided into a training set (n = 47) and a validation set (radiomics-guided group, n = 20). The patients were intervened with ultrasound radiomics-guided iliac fascia block, and the maximum relevance minimum redundancy sifts out the image omics features obtained from 2D ultrasound images of patients. Another 20 patients undergone general anesthesia served as control. The incidence of POCD, the total amount of fentanyl, the visual analogue score (VAS) at different time points, and the levels of CRP and NSE in plasma were compared between the two groups. Results The AUC on the training and validation sets were higher than 0.940. The incidence of POCD in the radiomics-guided and general anesthesia group was 5% and 30%, respectively (P = 0.037). Compared with the general anesthesia group, the dosage of fentanyl in the radiomics-guided was lower, the VAS score at 6 h, 1 d, and 2 d after operation was smaller, and the levels of CRP and NSE were lower (all P < 0.05). Conclusions For elderly patients with hip surgery, the ultrasound radiomics-guided iliac fascia block can reduce the incidence of POCD and improve the effect of nerve block.

One major concern in about one third of elder patients after total hip-replacement surgery is post-operative cognitive dysfunction (POCD). Previous studies have suggested that cognitive impairment is accompanied with changes in serum S-100β protein (S-100β) and inflammatory markers. Thus, the aim of the current study was to investigate the value of serum S-100β and interleukin(IL)-1β, IL-6, tumour necrosis factor-α (TNF-α), and C-reactive protein (CRP) in reflecting POCD after total hip-replacement surgery. Forty-two elderly patients were enrolled, and 37 patients completed the follow-up. Serum S-100β protein and IL-1β, IL-6, TNF-α, and CRP were determined pre-operatively, as well as 1 h and 6 h post-operatively. Neuropsychological tests were performed pre-operatively, as well as on day 1, 3, and 7 post-operatively. Seventeen (45.9%, 17/37) patients developed POCD 1 day after surgery, and three (8.1%, 3/37) developed POCD 7 days after surgery. [Correction added after publication 7 February 2012: in the preceding sentence (54.1%, 17/37) was corrected to (45.9%, 17/37)]. Patients with POCD 1 day after surgery had significantly higher serum levels of IL-6 at 6 h (135 ± 32 pg/ml vs. 91 ± 29 pg/ml, P < 0.05) and S-100β at 1 h (1872 ± 385 pg/ml vs. 1289 ± 143 pg/ml, P < 0.05. No significant post-operative change was detected in levels of TNF-α, IL-1, or CRP. The serum levels of pro-inflammatory marker IL-6 and S-100β protein increased after total hip-replacement in elderly patients, and such increase may serve as predicting parameters for the occurrence of POCD.

Postoperative cognitive dysfunction (POCD) is a common postoperative complication observed in elderly patients. However, the diagnosis of POCD is not very satisfactory as no specific biomarkers have been classified. It is necessary to identify new diagnostic markers to better understand the pathogenesis of POCD. We performed liquid chromatography with a time-of-flight mass spectrometer- (LC/Q-TOF-MS-) based metabolomics study to investigate POCD. A total of 40 metabolites were differentially expressed between POCD and non-POCD patients. In this study, we investigated whether phosphatidylserine (PS) (17:2/0:0), with an area under the curve value of 0.966, was a potential sensitive and specific biomarker for the diagnosis and prognosis of POCD. Pathway analysis showed that fatty acid metabolism, lipid metabolism, and carnitine metabolism were significantly altered in POCD. Network analysis indicated that nitric oxide signaling, PI3K-AKT signaling, mTOR signaling, and mitochondrial dysfunction were related to the pathogenesis of POCD. This study showed that metabolic profiling was meaningful when studying the diagnosis and pathogenesis of POCD.