Postoperative cognitive dysfunction in middle-aged patients.
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.
Johnson
Tim
T
Department of Anaesthesia, Hope Hospital, Salford, United Kingdom. tim.johnson@hope.srht.nwest.nhs.uk
Monk
Terri
T
Rasmussen
Lars S
LS
Abildstrom
Hanne
H
Houx
Peter
P
Korttila
Kari
K
Kuipers
Harrie M
HM
Hanning
Chris D
CD
Siersma
Volkert D
VD
Kristensen
Diana
D
Canet
Jaume
J
Ibañaz
Maria Teresa
MT
Moller
Jakob T
JT
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