title: Incidence and risk factors for cognitive dysfunction in patients with severe systemic disease.
abstract: OBJECTIVE
  To determine the relevance of surgery and other causative factors to the incidence of postoperative cognitive dysfunction (POCD) in patients with severe systemic disease.
  
  
  METHODS
  This observational study included 107 noncardiac surgical patients and 26 nonsurgical control  subjects, all of whom had an American Society of Anesthesiologists physical classification status of 3. Cognitive assessment was performed preoperatively and 7 days postoperatively, or with a 7-day interval for the control group. POCD was calculated as a combined Z-score. Mini Mental  State Examination (MMSE) was used to exclude patients with pre-existing cognitive deficit (MMSE score ≤ 23). Surgical and other factors including duration of surgery/anaesthesia and length of stay in the intensive care unit (ICU) were recorded.
  
  
  RESULTS
  After 7 days, POCD was found in 40/107  (37.4%) surgical patients compared with 4/26 (15.4%) nonsurgical controls. Preoperative MMSE score, duration of surgery/anaesthesia, and length of stay in the ICU and hospital were associated with POCD. Logistic regression analysis revealed that preoperative MMSE score was an independent predictor  of POCD.
  
  
  CONCLUSIONS
  Lower baseline MMSE score was the only independent predictor for POCD in patients with severe systemic disease.
authors.affiliation: Department of Anaesthesia and Surgical Intensive Care, Charité - University of Medicine Berlin, Berlin, Germany.
authors.forename: F M
authors.initials: FM
authors.lastname: Radtke
authors.forename: M
authors.initials: M
authors.lastname: Franck
authors.forename: T S
authors.initials: TS
authors.lastname: Herbig
authors.forename: N
authors.initials: N
authors.lastname: Papkalla
authors.forename: R
authors.initials: R
authors.lastname: Kleinwaechter
authors.forename: F
authors.initials: F
authors.lastname: Kork
authors.forename: W R
authors.initials: WR
authors.lastname: Brockhaus
authors.forename: K-D
authors.initials: KD
authors.lastname: Wernecke
authors.forename: C D
authors.initials: CD
authors.lastname: Spies
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects*; D003072:Cognition Disorders / Q000209:etiology*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications