Does Preoperative Cognitive Optimization Improve Postoperative Outcomes in the Elderly?

Yumiko Ishizawa

doi:10.3390/jcm11020445

Abstract

Perioperative neurocognitive disorder (PND) is a growing concern, affecting several million elderly patients each year in the United States, but strategies for its effective prevention have not yet been established. Humeidan et al. recently demonstrated that preoperative brain exercise resulted in a decrease in postoperative delirium incidence in elderly surgical patients, suggesting the potential of presurgical cognitive optimization to improve postoperative cognitive outcomes. This brief review summarizes the current knowledge regarding preoperative cognitive optimization and highlights landmark studies, as well as current ongoing studies, as the field is rapidly growing. This review further discusses the benefit of cognitive training in non-surgical elderly populations and the role of cognitive training in patients with preexisting cognitive impairment or dementia. The review also examines preclinical evidence in support of cognitive training, which can facilitate understanding of brain plasticity and the pathophysiology of PND. The literature suggests positive impacts of presurgical cognitive optimization, but further studies are encouraged to establish effective cognitive training programs for elderly presurgical patients.

Highlights

Improve Postoperative Outcomes in Perioperative neurocognitive disorder (PND) affects a growing population of older adults
It is critical to further investigate whether preoperative cognitive training could decrease the incidence of PND or improve the trajectory of cognitive decline in elderly surgical patients
There are a multitude of questions that need to be answered in order to establish effective cognitive training programs

Summary

Introduction

Improve Postoperative Outcomes in Perioperative neurocognitive disorder (PND) affects a growing population of older adults. Older age and preexisting cognitive impairment are the most important preoperative risk factors (predisposing factors) for PND [19,20]. Precipitating factors such as anesthetic drugs, surgery, and pain are thought to trigger POD or to promote cognitive dysfunction [21,22]. Efforts have been made to optimize predisposing factors of PND, such as preexisting cognitive impairment This brief review aims to summarize the current knowledge regarding preoperative optimization, focusing on cognitive optimization, and will discuss whether preoperative optimization improves postoperative cognitive outcomes in elderly surgical patients. A focused literature search for articles published between the years 2000 and 2021 was performed in PubMed using relevant terms, including preoperative optimization, cognitive training, perioperative neurocognitive disorder, postoperative delirium, and advanced age. This may help in understanding the pathophysiology of PND and guide future investigations on the role of cognitive optimization in preventing PND and age-related cognitive disorders

Preoperative Cognitive Assessment

Presurgical Cognitive Optimization

Preclinical Studies

Findings

Conclusions