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Br J Anaesth. 2018 Nov;121(5):1005-1012. doi: 10.1016/j.bja.2017.11.087. Epub 2018 Jun 15.

Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018.

Author information

1
St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia; University of Melbourne, Fitzroy, Victoria, Australia. Electronic address: lis.evered@svha.org.au.
2
St Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia; University of Melbourne, Fitzroy, Victoria, Australia.
3
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
4
Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.
5
Department of Anaesthesia, Center of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
6
Division of Geriatric Medicine and Gerontology, the Johns Hopkins University School of Medicine, Baltimore, MD, USA.
7
Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA.
8
Neurologic Outcomes Research Group, Anesthesiology Department, Duke University Medical Center, Durham, NC, USA.
9
Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
10
St. Vincent's Hospital Melbourne & University of Melbourne, Australia.
11
Department of Anesthesiology and Critical Care, University of Pennsylvania, School of Medicine, Philadelphia, PA, USA.
12
University of Melbourne, Academic Unit for Psychiatry of Old Age, Melbourne Australia.
13
Department of Anesthesiology, Department of Physiology and Pharmacology, Rutgers New Jersey Medical School, Newark, NJ, USA.
14
Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
15
Department of Psychiatry & Behavioral Sciences, Division of Geriatric Behavioral Health, Duke University Medical Center, Durham, NC, USA.
16
Department of Anesthesiology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
17
University Medical Center Utrecht, Utrecht, The Netherlands.
18
McKnight Brain Institute, Department of Neurology, College of Medicine, University of Florida, Gainesville FL, USA.
19
Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
20
Shiley-Marcos Alzheimer's Disease Research Center, Department of Neurosciences, University of California, San Diego, CA, USA.
21
Department of Anesthesiology, University of Wisconsin, WI, USA.
22
Beth Israel Deaconess Medical Center, Harvard Medical School, Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
23
Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Johns Hopkins University, Baltimore, MD, USA.
24
Harvard Medical School, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
25
Centre for Neuroscience, University of Melbourne, Melbourne, Australia.
26
Department of Anaesthesia and Perioperative Care, UCSF, Center for Cerebrovascular Research, Zuckerberg San Francisco General, San Francisco, CA, USA.
27
Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Balt, MD, USA.
28
University of Toronto, Department of Anaesthesia, Sunnybrook Health Science Centre, Toronto, Canada.
29
Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands.
30
Clinical & Health Psychology, University of Florida, College of Public Health and Health Professions, Gainesville, FL, USA.
31
Department of Anaesthesia, Center of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Denmark.
32
Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine & Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, Australia.
33
Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA.
34
Department of Anaesthesia/Critical Care Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
35
Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USA.
36
Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Denmark.
37
Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
38
Indiana University School of Medicine, Indianapolis, IN, USA.
39
Columbia University College of Physicians and Surgeons, New York, NY, USA.
40
Harvard Medical School, Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Charlestown, MA, USA.

Abstract

Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face-to-face meetings followed by online editing of draft versions. Two major classification guidelines [Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) and National Institute for Aging and the Alzheimer Association (NIA-AA)] are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that 'perioperative neurocognitive disorders' be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).

KEYWORDS:

cognition disorders; delirium; neurocognitive disorders; postoperative complications

PMID:
30336844
DOI:
10.1016/j.bja.2017.11.087
[Indexed for MEDLINE]

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