References

Ansaloni L, Catena F, Chattat R Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg.. 2010; 97:(2)273-80 https://doi.org/10.1002/bjs.6843

Bekker A, Lee C, de Santi S Does mild cognitive impairment increase the risk of developing postoperative cognitive dysfunction?. Am J Surg.. 2010; 199:(6)782-788 https://doi.org/10.1016/j.amjsurg.2009.07.042

Black P, Boore JRP, Parahoo K. The effect of nurse-facilitated family participation in the psychological care of the critically ill patient. J Adv Nurs.. 2011; 67:(5)1091-1101 https://doi.org/10.1111/j.1365-2648.2010.05558.x

Brooks P, Spillane JJ, Dick K, Stuart-Shor E. Developing a strategy to identify and treat older patients with postoperative delirium. AORN J. 2014; 99:(2)256-276 https://doi.org/10.1016/j.aorn.2013.12.009

Brown C, Deiner S. Perioperative cognitive protection. Br J Anaesth. 2016; 117:iii52-iii61 https://doi.org/10.1093/bja/aew361

Carrascal Y, Guerrero AL. Neurological damage related to cardiac surgery: pathophysiology, diagnostic tools and prevention strategies. Using actual knowledge for planning the future. Neurologist. 2010; 16:(3)152-164 https://doi.org/10.1097/NRL.0b013e3181bd602b

Chaput AJ, Bryson GL. Postoperative delirium: risk factors and management: continuing professional development. Can J Anaesth. 2012; 59:(3)304-20 https://doi.org/10.1007/s12630-011-9658-4

Chevillon C, Hellyar M, Madani C, Kerr K, Kim SC. Preoperative education on postoperative delirium, anxiety, and knowledge in pulmonary thromboendarterectomy patients. Am J Crit Care. 2015; 24:(2)164-171 https://doi.org/10.4037/ajcc2015658

Davous P, Lamour Y, Debrand E, Rondot P. A comparative evaluation of the short orientation memory concentration test of cognitive impairment. J Neurol Neurosurg Psychiatry. 1987; 50:(10)1312-1317 https://doi.org/10.1136/jnnp.50.10.1312

De J, Wand APF, Smerdely PI, Hunt GE. Validating the 4A's test in screening for delirium in a culturally diverse geriatric inpatient population. Int J Geriatr Psychiatry. 2017; 32:(12)1322-1329 https://doi.org/10.1002/gps.4615

The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. BMC Med. 2014; 12:(1) https://doi.org/10.1186/s12916-014-0141-2

Evered L, Scott DA, Silbert B, Maruff P. Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesth Analg.. 2011; 112:(5)1179-1185 https://doi.org/10.1213/ANE.0b013e318215217e

Evered LA, Silbert BS. Postoperative cognitive dysfunction and noncardiac surgery. Anesth Analg.. 2018; 127:(2)496-505 https://doi.org/10.1213/ANE.0000000000003514

Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK. The interface between delirium and dementia in elderly adults. Lancet Neurol. 2015; 14:(8)823-832 https://doi.org/10.1016/S1474-4422(15)00101-5

Hartjes TM, Meece L, Horgas AL. CE: assessing and managing pain, agitation, and delirium in hospitalized older adults. Am J Nurs. 2016; 116:(10)38-46 https://doi.org/10.1097/01.NAJ.0000503300.22262.c7

Hshieh TT, Inouye SK, Oh ES. Delirium in the elderly. Psychiatr Clin North Am. 2018; 41:(1)1-17 https://doi.org/10.1016/j.psc.2017.10.001

ICD-10-CM. ICD-10-CM diagnosis code F05: delirium due to known physiological condition. 2019. http://tinyurl.com/yyj458dv (accessed 27 March 2019)

Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990; 941-948

Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014; 383:(9920)911-922 https://doi.org/10.1016/S0140-6736(13)60688-1

Kazmierski J, Banys A, Latek J Mild cognitive impairment with associated inflammatory and cortisol alterations as independent risk factor for postoperative delirium. Dement Geriatr Cogn Disord. 2014; 38:(1-2)65-78 https://doi.org/10.1159/000357454

Kosar CM, Tabloski PA, Travison TG Effect of preoperative pain and depressive symptoms on the risk of postoperative delirium: a prospective cohort study. Lancet Psychiatry. 2014; 1:(6)431-436 https://doi.org/10.1016/S2215-0366(14)00006-6

Krenk L, Rasmussen L. Postoperative delirium and postoperative cognitive dysfunction in the elderly—what are the differences?. Minerva Anestesiol. 2011; 77:(7)742-749

Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008; 168:(1)27-32 https://doi.org/10.1001/archinternmed.2007.4

Maclullich AM, Ferguson KJ, Miller T, de Rooij SE, Cunningham C. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res. 2008; 65:(3)229-238 https://doi.org/10.1016/j.jpsychores.2008.05.019

Marcantonio ER. Postoperative delirium: a 76-year-old woman with delirium following surgery. JAMA. 2012; 308:(1)73-81 https://doi.org/10.1001/jama.2012.6857

Moller JT, Cluitmans P, Rasmussen LS Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998; 351:(9106)857-861 https://doi.org/10.1016/S0140-6736(97)07382-0

Nadelson MR, Sanders RD, Avidan MS. Perioperative cognitive trajectory in adults. Br J Anaesthesia. 2014; 112:(3)440-451 https://doi.org/10.1093/bja/aet420

Newman S, Stygall J, Hirani S, Shaefi S, Maze M. Postoperative cognitive dysfunction after noncardiac surgery: a systematic review. Anesthesiology. 2007; 106:(3)572-590 https://doi.org/10.1097/00000542-200703000-00023

Ribeiro Filho ST, Lourenço RA. The performance of the Mini-Cog in a sample of low educational level elderly. Dement Neuropsychol. 2009; 3:(2)81-87 https://doi.org/10.1590/S1980-57642009DN30200003

Riedel B, Browne K, Silbert B. Cerebral protection: inflammation, endothelial dysfunction, and postoperative cognitive dysfunction. Curr Opin Anaesthesiol. 2014; 27:(1)89-97 https://doi.org/10.1097/ACO.0000000000000032

Rudolph JL, Marcantonio ER. Review articles: postoperative delirium: acute change with long-term implications. Anesth Analg.. 2011; 112:(5)1202-11 https://doi.org/10.1213/ANE.0b013e3182147f6d

Sachdev PS, Blacker D, Blazer DG Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol. 2014; 10:(11)634-42 https://doi.org/10.1038/nrneurol.2014.181

Saczynski JS, Marcantonio ER, Quach L Cognitive trajectories after postoperative delirium. N Engl J Med. 2012; 367:(1)30-9 https://doi.org/10.1056/NEJMoa1112923

Saczynski JS, Inouye SK, Kosar CM Cognitive and brain reserve and the risk of postoperative delirium in older patients: analysis of data from a prospective observational study. Lancet Psychiatry. 2014; 1:(6)437-443 https://doi.org/10.1016/S2215-0366(14)00009-1

Schulte PJ, Roberts RO, Knopman DS Association between exposure to anaesthesia and surgery and long-term cognitive trajectories in older adults: report from the Mayo Clinic Study of Aging. Br J Anaesth. 2018; 121:(2)398-405 https://doi.org/10.1016/j.bja.2018.05.060

Steinmetz J, Christensen KB, Lund T, Lohse N, Rasmussen LS Long-term consequences of postoperative cognitive dysfunction. Anesthesiology. 2009; 110:(3)548-555 https://doi.org/10.1097/ALN.0b013e318195b569

Svenningsen H. A shared language regarding sedation and delirium in critically ill patients. Nurs Crit Care. 2015; 20:(4)204-209

Taipale PG, Ratner PA, Galdas PM The association between nurse-administered midazolam following cardiac surgery and incident delirium: an observational study. Int J Nurs Stud. 2012; 49:(9)1064-1073 https://doi.org/10.1016/j.ijnurstu.2012.03.008

Terrando N, Eriksson LI, Eckenhoff RG. Perioperative neurotoxicity in the elderly: summary of the 4th International Workshop. Anesth Analg.. 2015; 120:(3)649-52 https://doi.org/10.1213/ANE.0000000000000624

Vaupel JW. Biodemography of human ageing. Nature. 2010; 464:(7288)536-542 https://doi.org/10.1038/nature08984

Weinrebe W, Johannsdottir E, Karaman M, Füsgen I. What does delirium cost? An economic evaluation of hyperactive delirium. Z Gerontol Geriatr. 2016; 49:(1)52-58 https://doi.org/10.1007/s00391-015-0871-6

Wofford K, Vacchiano C. Sorting through the confusion: adverse cognitive change after surgery in adults. AANA J. 2011; 79:(4)335-342

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

11 April 2019

Focus

02 April 2019

Volume 28 · Issue 7

ISSN (print): 0966-0461

ISSN (online): 2052-2819

Abstract

Background:

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

Aim:

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.

Method:

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.

Conclusion:

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.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

Limited access to clinical or professional articles
Unlimited access to the latest news, blogs and video content

Or continue by

Signing in with your registered email address

Postoperative delirium

Postoperative cognitive dysfunction

Cognitive decline

Anaesthesia

Noncardiac surgery

Postoperative care