Postoperative cognitive dysfunction in older patients with a history of alcohol abuse.
BACKGROUND
Postoperative cognitive dysfunction (POCD) affects a significant number of patients and may have serious consequences for quality of life. Although POCD is most frequent after cardiac surgery, the prevalence of POCD after noncardiac surgery in older patients is also significant. The risk factors for POCD after noncardiac surgery include advanced age and preexisting cognitive impairment. Self-reported alcohol abuse is a risk factor for postoperative delirium, but its significance for long-term POCD has not been investigated. The goal of this study was to determine whether neurocognitive function is impaired after noncardiac surgery during general anesthesia in older patients with a history of alcohol abuse.


METHODS
Subjects aged 55 yr and older with self-reported alcohol abuse (n = 28) and age-, sex-, education-matched nonalcoholic controls (n = 28) were tested using a neurocognitive battery before and 2 weeks after elective surgery (n = 28) or a corresponding time interval without surgery (n = 28). Verbal memory, visuospatial memory, and executive functions were assessed. A neurologic examination was performed to exclude subjects with potential cerebrovascular damage.


RESULTS
Significant three-way interactions (analysis of variance) for Visual Immediate Recall, Visual Delayed Recall, Semantic Fluency, Phonemic Fluency, and the Color-Word Stroop Test implied that cognitive performance in the alcoholic group decreased after surgery more than it did in the other three groups.


CONCLUSIONS
The results suggest that a history of alcohol abuse in older patients presents a risk for postoperative cognitive impairment in the domains of visuospatial abilities and executive functions that may have important implications for quality of life and health risks.
Hudetz
Judith A
JA
Clinical Research, Department of Anesthesiology, Medical College of Wisconsin and Zablocki Veterans Administration Medical Center, Milwaukee, Wisconsin 53295, USA. judith.hudetz@va.gov
Iqbal
Zafar
Z
Gandhi
Sweeta D
SD
Patterson
Kathleen M
KM
Hyde
Trevor F
TF
Reddy
Diane M
DM
Hudetz
Anthony G
AG
Warltier
David C
DC
D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000453:epidemiology*; D000704:Analysis of Variance; D000768:Anesthesia, General / Q000009:adverse effects; D003071:Cognition / Q000187:drug effects; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D017558:Elective Surgical Procedures / Q000009:adverse effects; D006801:Humans; D008297:Male; D008570:Memory, Short-Term / Q000187:drug effects; D011939:Mental Recall / Q000187:drug effects; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D013028:Space Perception / Q000187:drug effects; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D014796:Visual Perception / Q000187:drug effects