Older surgical patients at greater risk for developing cognitive problems

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Public release date: 2-Jan-2008

http://www.eurekalert.org/pub_releases/2008-01/dumc-osp010208.php

Contact: Shaftel

lauren.shaftel@...

Duke University Medical Center

Older surgical patients at greater risk for developing cognitive problems

DURHAM, N.C. -- Patients over the age of 60 who have elective surgeries

such as joint replacements, hysterectomies and other non-emergency,

inpatient procedures, are at an increased risk for long-term cognitive

problems, according to a new study led by Duke University Medical Center

researchers.

The study also found that elderly patients who developed these

postoperative cognitive problems were more likely to die in the first

year after surgery.

“We have known that patients undergoing heart surgery are at risk for

cognitive dysfunction -- problems with memory, concentration, processing

of information -- but the effects of non-cardiac surgeries on brain

function are not as well-understood,” said Terri Monk, M.D., an

anesthesiologist at Duke and the Durham Veterans Affairs Medical Center,

and lead investigator on the study. “Our study found that increasing age

put patients in this population at greater risk for cognitive problems

and this is significant because the elderly are the fastest growing

segment of the population. We know that half of all people 65 and older

will have at least one surgery in their lifetime.”

The researchers published their findings in the January 1, 2008 issue of

the journal Anesthesiology and the results were published early online

on December 27, 2007 on the journal’s Web site. The article is

accompanied by a supportive editorial and a companion article detailing

the types of cognitive dysfunction that developed and the effects on

patients’ daily lives. The study was funded by the National Institute on

Aging, the Anesthesia Patient Safety Foundation and the I. Heerman

Foundation.

The researchers measured memory and the ability to process information

in more than 1000 adult patients of different ages. Patients were tested

preoperatively, at the time of hospital discharge, and three months

after surgery. More than 200 control subjects took the same tests at the

same frequency, but did not undergo surgery or anesthesia.

The study found that many of the young, middle-aged and elderly patients

experienced postoperative cognitive dysfunction (POCD) at the time they

left the hospital. But three months later, those aged 60 and older were

more than twice as likely to exhibit POCD. Those with POCD at both the

time of hospital discharge and three months after surgery also were more

likely to die within the first year after surgery, Monk said.

“The large difference in the prevalence of POCD between what we termed

the elderly -- those aged 60 and over -- and the younger groups we were

studying validates the general perception that the elderly are

predisposed to cognitive impairment after major surgery,” Monk said.

POCD was more common among those patients with lower educational level

and a history of a stroke that had left no noticeable neurologic impairment.

“Education protected against postoperative cognitive problems, likely

because education may provide an opportunity to condition the brain, and

better equip it to withstand injury, much like physical exercise has a

protective effect on the body,” Monk said.

The reasons why cognitive decline is associated with early death are not

completely understood, but it’s possible that patients with prolonged

cognitive dysfunction might be less able to take medicines correctly or

may not recognize the need to seek medical care for symptoms of

complications, Monk said.

“Studies on normal aging have shown a link between abrupt cognitive

decline and early death, so we speculated that surgery-related cognitive

dysfunction might have the same effect,” she said.

Why some patients suffer POCD is not known, but one hypothesis is that

surgery and the accompanying anesthesia might cause inflammation in the

brain that can affect the patient’s ability to learn, retain or remember

information, Monk said.

Now that the implications of long-term POCD are better understood,

doctors must devise strategies to prevent or mitigate the detrimental

effects of surgery and anesthesia on the aging brain, Monk said. The

types of interventions and how to implement them will be the subject of

further research, she said.

###

Other researchers on this study include B. Craig Weldon of Duke; and

Cyndi Garvan, Duane Dede, van der Aa, Heilman and Joachim

Gravenstein of the University of Florida.

--

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