title: Postoperative cognitive dysfunction in middle-aged patients.
abstract: BACKGROUND
  Postoperative cognitive dysfunction (POCD) after noncardiac surgery is strongly associated with increasing age in elderly patients; middle-aged patients (aged 40-60 yr) may be expected to have a lower incidence, although subjective complaints are frequent.
  
  
  METHODS
  The authors compared the changes in neuropsychological test results at 1 week and 3 months in patients aged 40-60 yr, using a battery of neuropsychological tests, with those of age-matched control subjects using Z-score analysis. They assessed risk factors and associations of POCD with measures of subjective cognitive function, depression, and activities of daily living.
  
  
  RESULTS
  At 7 days, cognitive dysfunction as defined was present in 19.2% (confidence interval [CI], 15.7-23.1) of the patients and in 4.0% (CI, 1.6-8.0) of control subjects (P < 0.001). After 3 months, the incidence was 6.2% (CI, 4.1-8.9) in patients and 4.1% (CI, 1.7-8.4) in control subjects (not significant). POCD at 7 days was associated with supplementary epidural analgesia and reported avoidance of alcohol consumption. At 3 months, 29% of patients had subjective symptoms of POCD, and this finding was associated with depression. Early POCD was associated with reports of lower activity scores at 3 months.
  
  
  CONCLUSIONS
  Postoperative cognitive dysfunction occurs frequently but resolves by 3 months after surgery. It may be associated with decreased activity during this period. Subjective report overestimates the incidence of POCD. Patients may be helped by recognition that the problem is genuine and reassured that it is likely to be transient.
authors.affiliation: Department of Anaesthesia, Hope Hospital, Salford, United Kingdom. tim.johnson@hope.srht.nwest.nhs.uk
authors.forename: Tim
authors.initials: T
authors.lastname: Johnson
authors.forename: Terri
authors.initials: T
authors.lastname: Monk
authors.forename: Lars S
authors.initials: LS
authors.lastname: Rasmussen
authors.forename: Hanne
authors.initials: H
authors.lastname: Abildstrom
authors.forename: Peter
authors.initials: P
authors.lastname: Houx
authors.forename: Kari
authors.initials: K
authors.lastname: Korttila
authors.forename: Harrie M
authors.initials: HM
authors.lastname: Kuipers
authors.forename: Chris D
authors.initials: CD
authors.lastname: Hanning
authors.forename: Volkert D
authors.initials: VD
authors.lastname: Siersma
authors.forename: Diana
authors.initials: D
authors.lastname: Kristensen
authors.forename: Jaume
authors.initials: J
authors.lastname: Canet
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Ibañaz
authors.forename: Jakob T
authors.initials: JT
authors.lastname: Moller
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D013997:Time Factors