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Postoperative cognitive decline: the nurse's role in identifying this underestimated and misinterpreted condition

11 April 2019
Volume 28 · Issue 7



postoperative cognitive changes can increase morbidity and mortality, demand for postoperative care and social and health costs, and can lead to dementia.


this article discusses perioperative variables that can be used to identify patients who are more vulnerable to experiencing cognitive decline after surgery. It also highlights some screening tools that could be useful for early detection and for planning nursing care.


a literature search was conducted using the Medline, CINAHL, PsychINFO and Cochrane Library databases from 2010 to 2018. Google Scholar was also consulted. The reference lists of relevant articles covering postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) were reviewed for further relevant papers.


assessment and evaluation of a patient's cognitive resources before and after surgery can lead to clinical interventions to support the person's coping mechanisms; health professionals can reduce the short- and long-term effects of cognitive decline. Screening tools could be used as part of a strategy to minimise postoperative cognitive changes.

General improvements in living conditions have led to a great increase in the number of elderly patients and it is estimated that people over 65 years of age will make up the largest proportion of the surgical population by 2020 (Vaupel, 2010). This group is more vulnerable to developing postoperative cognitive alterations (Schulte et al, 2018). Cognitive changes after surgery are often misinterpreted because of multifactorial aetiology, subtle clinical presentation and the lack of widely available, validated tools for identification (Wofford and Vacchiano, 2011). These postoperative changes may persist for longer than 1 year after surgery. Initial cognitive decline can be followed by delayed or incomplete recovery, leading to increased complications, delayed discharge because of functional decline, a decrease in long-term memory, increased mortality and higher health and social care costs (Saczynski et al, 2012; Chevillon et al, 2015). Cognitive dysfunction frequently arises in elderly patients after surgery, and ranges from a transient disorder of attention or awareness to a persistent decline in postoperative cognitive status.

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