Sandeep Bhushan1, Yuan Li2, Xin Huang3, Han Cheng4, Ke Gao5, Zongwei Xiao6. 1. Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China. Electronic address: dr.sandeep07@yahoo.com. 2. Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China. Electronic address: 403691944@qq.com. 3. Department of Anesthesiology, West China Hospital of Medicine, Sichuan University, Sichuan, 610017, China. Electronic address: 604680675@qq.com. 4. Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China. Electronic address: 31864462@qq.com. 5. Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China. Electronic address: 1615408076@qq.com. 6. Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China. Electronic address: zongweixiao@163.com.
Abstract
BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common complication of central nervous system in middle-aged and elderly patients after cardiac surgery. The purpose of this study was to review the progress in diagnosis, pathogenesis and risk factors and control strategy of POCD. METHODS: A systematic literature search was conducted using Pubmed and EMBASE, using the Mesh terms and key words "POCD", "diagnostic criteria", "pathogenesis", "influencing factors" and "prevention strategies". Studies were retained for review after meeting strict inclusion criteria that included only prospective studies evaluating risk factors for POCD in patients who had elective cardiac surgery. Diagnosis of POCD needed to be confirmed using the Diagnostic and Statistical Manual of Montreal Cognitive Assessment (MoCA) Scale and other criteria. RESULTS: "Twenty two articles were selected for inclusion. The incidence of POCD across the studies ranged from 9% to 54%. Multiple factors have been associated with the pathogenesis and increased risk of POCD, including neuroinflammation, dysfunction of cholinergic system, abnormal protein function (β-amyloid), old age, anesthetic, surgical and other factors." CONCLUSIONS: POCD is a common complication after cardiac surgery in elderly. The highest POCD incidence was observed after open aortic, TAVI and CABG surgery. Age, cognitive function, depression, CPB and anesthetic use are leading risk factors. Further research is needed in determining interventions that will be effective in preventing and treating POCD in cardiac surgical setting.
BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common complication of central nervous system in middle-aged and elderly patients after cardiac surgery. The purpose of this study was to review the progress in diagnosis, pathogenesis and risk factors and control strategy of POCD. METHODS: A systematic literature search was conducted using Pubmed and EMBASE, using the Mesh terms and key words "POCD", "diagnostic criteria", "pathogenesis", "influencing factors" and "prevention strategies". Studies were retained for review after meeting strict inclusion criteria that included only prospective studies evaluating risk factors for POCD in patients who had elective cardiac surgery. Diagnosis of POCD needed to be confirmed using the Diagnostic and Statistical Manual of Montreal Cognitive Assessment (MoCA) Scale and other criteria. RESULTS: "Twenty two articles were selected for inclusion. The incidence of POCD across the studies ranged from 9% to 54%. Multiple factors have been associated with the pathogenesis and increased risk of POCD, including neuroinflammation, dysfunction of cholinergic system, abnormal protein function (β-amyloid), old age, anesthetic, surgical and other factors." CONCLUSIONS: POCD is a common complication after cardiac surgery in elderly. The highest POCD incidence was observed after open aortic, TAVI and CABG surgery. Age, cognitive function, depression, CPB and anesthetic use are leading risk factors. Further research is needed in determining interventions that will be effective in preventing and treating POCD in cardiac surgical setting.