A case of postoperative cognitive decline, with a highly elevated C- reactive protein, status post left ventricular assist device insertion: a review of the neuroinflammatory hypothesis of delirium.

Cognitive difficulties after surgery are a common complication and are associated with significant morbidity and mortality, which is concerning as the number of geriatric patients undergoing major procedures continues to rise. Postoperative cognitive impairment encompasses both postoperative delirium and postoperative cognitive decline. Delirium is a formal diagnosis and presents acutely while postoperative cognitive decline has yet to be defined and has a subtle presentation. Postoperative cognitive decline is a decline in cognitive function from baseline and has been described in elderly patients after cardiac surgery, such as coronary artery bypass graft. Although the etiology of postoperative cognitive decline has yet to be elucidated, it is most likely multifactorial with potential causes being surgery type, sleep disturbances, neuroinflammation, cerebral hypoperfusion, anesthesia, metabolic syndrome, and decreased cognitive reserve. In this case report, we present the first case of postoperative cognitive decline in a middle-age patient after left ventricular assist device placement.