Abstract
Surgery and anesthesia can result in temporary or permanent deterioration of the cognitive functions, for which causes remain unclear. In this pilot study, we analyzed the determinants of cognitive decline following a non-emergency elective prosthesis implantation surgery for hip or knee. Prospective single-center study investigating psychomotor response time and changes in MoCA scores between the day before (D-1) and 2 days after (D+2) following surgery at the Lariboisière Hospital (Paris, France). 60 patients (71.9±7.1-year-old, 72% women) were included. Collected data consisted in sociodemographic data, treatments, comorbidities and the type of anesthesia (local, general or both). Furthermore, we evaluated pain and well-being before as well as after the surgery using point scales. Post-operative (D+2) MoCA scores were significantly lower than pre-operative ones (D-1) with a median difference of 2 pts [IQR]=4pts, (p<0.001), we found no significant difference between locoregional and general anesthesia. Pre-operative benzodiazepine or anticholinergic treatments were also associated to a drop in MoCA scores (p=0.006). Finally, the use of ketamine during anesthesia (p=0.043) and the well-being (p=0.006) evaluated before intervention, were both linked to a reduced cognitive impact. In this pilot study, we observed a post-operative short-term cognitive decline following a lower limb surgery. We also identified pre and perioperative independent factors linked to cognitive decline following surgery. In a next stage, a larger cohort should be used to confirm the impact of these factors on cognitive decline.
Highlights
Post-Operative Cognitive Decline (POCD) is a major cause of mortality and morbidity costing over $150 billion dollars yearly in health care expenses in the United States (Braunwald, et al 2001)
We investigated if Montreal Cognitive Assessment (MoCA) scores obtained one day before (D-1), two days after (D+2) and six weeks (W+6) following the surgery were significantly different
We found no significant difference between D-1 and W+6 (MoCA median[IQR]: 24[3.5] versus 24 [4], p-value= 0.831), among the 31 patients evaluated at 6 weeks, 32% did not recovered their baseline level score
Summary
Post-Operative Cognitive Decline (POCD) is a major cause of mortality and morbidity costing over $150 billion dollars yearly in health care expenses in the United States (Braunwald, et al 2001). POCD includes postoperative delirium, NeuroCognitive Disorder (NCD) and delayed NeuroCognitive Recovery (Mahanna-Gabrielli, et al 2019). NCD definition from the DSM-V consists in a significant cognitive decline from a previous level of performance, diagnosed at least 30 days after the surgery and assessed by standardized neuropsychological testing. Delayed NeuroCognitive Recovery are tested using the same criteria as for NCD except that the diagnosis window must be less than 30 days after the intervention (Mahanna-Gabrielli, et al 2019). Diagnosing NCD and delayed NeuroCognitive Recovery requires preoperative cognitive status along with additional stages into the routine care.
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