British Journal of Anaesthesia, Vol 82, Issue 6 867-874, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
J. B. Dijkstra, P. J. Houx and J. Jolles
There is evidence that older people in particular have a higher risk of
cognitive dysfunction after surgery under general anaesthesia. We have
investigated the severity and character of postoperative cognitive
dysfunction after major non-cardiac surgery in patients older than 65 yr.
Also, cognitive complaints were studied. Cognitive function was assessed
using cognitive tests measuring memory and attention, such as ability to
shift between two sequences, ability to ward off distractions, simple
cognitive speed and speed of general information processing. These tests
were performed before, 1 week (short-term) and 3 months (long-term) after
surgery. Cognitive performance of the patients was compared with that of
healthy subjects not undergoing surgery who were also subjected to repeated
cognitive measurements. After 1 week, patients had a poorer performance on
tests measuring simple cognitive speed and speed of general information
processing. Three months after surgery, patients and controls showed
improved cognitive performance compared with the first measurement. These
results suggest that major non-cardiac surgery in older patients causes
short-term but not long-term cognitive dysfunction. However, after 6
months, 14 of 48 patients (29%) reported having experienced a decline in
cognitive abilities after discharge from hospital. Eight of these 14
patients (17%) were still experiencing these cognitive complaints and
reported 'not being the same since the operation'. These findings emphasize
that cognitive complaints after major surgery may not reflect actual
changes in cognitive performance but may be caused by other factors such as
depression or awareness of age-related changes.
CLINICAL INVESTIGATIONS
Cognition after major surgery in the elderly: test performance and complaints
Maastricht Brain and Behaviour Research Institute and Department of Psychiatry and Neuropsychology, University of Maastricht, The Netherlands
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