1
|
Arias F, Chen F, Shiff H, Marcantonio ER, Jones RN, Schmitt EM, Metzger E, Fong TG, Travison TG, Inouye SK. Parental Education and Delirium Risk after Surgery in Older Adults. Clin Gerontol 2023; 46:253-266. [PMID: 36001869 PMCID: PMC9928599 DOI: 10.1080/07317115.2022.2111289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Efforts to conceptualize risk factors for postoperative delirium in older adults have focused on the time proximate to the episode, but how early-life exposures influence delirium risk is poorly understood. METHODS An observational cohort of 547 patients aged 70+undergoing major non-cardiac surgery at two academic medical centers in Boston. Demographic characteristics, cognition, parental education, health, and participation in cognitively stimulating activities were assessed prior to surgery. Delirium incidence and severity were measured daily during hospitalization. RESULTS Higher paternal education was associated with significantly lower incidence of delirium (X2(1, N =547)=8.35, p <.001; odds ratio OR=.93, 95% CI, .87 to .98) and inversely associated with delirium severity (r(545)=-.13, p <.001). Higher maternal education was associated with lower delirium incidence but did not reach statistical significance. The effect of paternal education on delirium incidence was independent of the patient's education, estimated premorbid intelligence, medical comorbidities, neighborhood disadvantage, and participation in cognitively stimulating activities (X2(2, N =547)=31.22, p <.001). CONCLUSIONS Examining early-life exposures may yield unique insights into the risks and pathogenesis of delirium. CLINICAL IMPLICATIONS Evaluating long-term factors that increase vulnerability to delirium may improve our ability to calculate risk. It may guide clinical decision-making and inform pre- and post-operative recommendations.
Collapse
Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - Fan Chen
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, USA
| | - Haley Shiff
- Harvard T. H. Chan School of Public Health, Boston, USA
| | - Edward R. Marcantonio
- Harvard Medical School, Boston, USA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, USA
| | - Eva M. Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
| | - Eran Metzger
- Department of Medicine, Hebrew SeniorLife, Boston, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, USA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - Thomas G. Travison
- Harvard Medical School, Boston, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, USA
- Department of Medicine and Psychiatry, Harvard Medical School, Boston, USA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Harvard Medical School, Boston, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| |
Collapse
|
2
|
Price CC. The New Frontier of Perioperative Cognitive Medicine for Alzheimer's Disease and Related Dementias. Neurotherapeutics 2022; 19:132-142. [PMID: 35084722 PMCID: PMC9130373 DOI: 10.1007/s13311-021-01180-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 01/03/2023] Open
Abstract
This is a review of preoperative cognitive assessment and other healthcare gaps in the care of older adults at risk for Alzheimer's disease and related dementias (ADRD) who have elected surgery with anesthesia. It summarizes concerns regarding ADRD perioperative healthcare, perioperative cognitive, and neuronal domains of vulnerability. It also offers a plan for phased preoperative cognitive screening and perioperative cognitive intervention opportunities. An argument is made for why medical professionals in the perioperative setting need fundamental training in cognitive-behavioral principles, an understanding of neurodegenerative diseases of aging, and an appreciation of the immediate and long-term medical risks for such patients undergoing anesthesia. The author's goal is to encourage readers to consider perioperative cognitive medicine as a new frontier for generating evidence-based care approaches for at-risk older adults with neurodegenerative disorders who require procedures with anesthesia.
Collapse
Affiliation(s)
- Catherine C Price
- Clinical and Health Psychology, Anesthesiology, University of Florida, Gainesville, FL, USA.
| |
Collapse
|
3
|
Buckley RA, Atkins KJ, Fortunato E, Silbert B, Scott DA, Evered L. A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: A feasibility study. Acta Anaesthesiol Scand 2021; 65:473-480. [PMID: 33296501 DOI: 10.1111/aas.13756] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/26/2020] [Accepted: 11/21/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND We developed a digital clock drawing test (dCDT), an adaptation of the original pen and paper clock test, that may be advantageous over previous dCDTs in the perioperative environment. We trialed our dCDT on a tablet device in the preoperative period to determine the feasibility of administration in this setting. To assess the clinical utility of this test, we examined the relationship between the performance on the test and compared derived digital clock measures with the 4 A's Test (4AT), a delirium and cognition screening tool. METHODS We recruited a sample of 102 adults aged 65 years and over presenting for elective surgery in a single tertiary hospital. Participants completed the 4AT, followed by both command and copy clock conditions of the dCDT. We recorded time-based clock-drawing metrics, alongside clock replications scored using the Montreal Cognitive Assessment (MoCA) clock scoring criteria. RESULTS The dCDT had an acceptance rate of 99%. After controlling for demographic variables and prior tablet use, regression analyses showed higher 4AT scores were associated with greater dCDT time (seconds) for both command (β = 8.2, P = .020) and copy clocks (β = 12, P = .005) and lower MoCA-based clock scores in both command (OR = 0.19, P = .001) and copy conditions (OR = 0.14, P = .012). CONCLUSION The digital clock drawing test is feasible to administer and is highly acceptable to older adults in a preoperative setting. We demonstrated a significant association between both the dCDT time and clock score metrics, with the established 4AT. Our results provide convergent validity of the dCDT in the preoperative setting.
Collapse
Affiliation(s)
- Richard A Buckley
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Faculty of Medicine, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kelly J Atkins
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Faculty of Medicine, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Erika Fortunato
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Brendan Silbert
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Faculty of Medicine, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - David A Scott
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Faculty of Medicine, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Lisbeth Evered
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Faculty of Medicine, School of Health Sciences, University of Melbourne, Melbourne, Australia
- Department of Anesthesiology, Weill Cornell Medicine, NY, USA
| |
Collapse
|
4
|
Hamlet K, Pasternak E, Rabai F, Mufti M, Alonso CH, Price CC. Perioperative Multidisciplinary Delirium Prevention: A Longitudinal Case Report. A A Pract 2021; 15:e01364. [PMID: 33443846 PMCID: PMC8011825 DOI: 10.1213/xaa.0000000000001364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Postoperative delirium is associated with accelerated cognitive decline, mortality, and high health care costs. The importance of perioperative risk identification is increasingly recognized but optimal prevention strategies are still evolving. We review the case of an at-risk 79-year-old who had 3 lumbar spine surgeries within a year, 2 of which were complicated by postoperative delirium and one which was not. We discuss how a comprehensive preoperative cognitive assessment successfully informed perioperative decision making, including anesthetic management and postoperative multimodal delirium prevention strategies by geriatric medicine. The case exemplifies how coordinated interdisciplinary team management may reduce postoperative delirium in high-risk individuals.
Collapse
Affiliation(s)
- Kristin Hamlet
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
- Department of Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, Florida
| | - Eliana Pasternak
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
- Department of Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, Florida
| | - Ferenc Rabai
- Department of Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, Florida
- Department of Gainesville, Florida; Anesthesiology, University of Florida, Gainesville, Fl
| | - Mariam Mufti
- Department of Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, Florida
- Department of Geriatric Medicine, University of Florida, Gainesville, FL, 32610, USA
| | - Carlos Hernaiz Alonso
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
- Department of Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, Florida
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
- Department of Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, Florida
| |
Collapse
|
5
|
Wiggins M, Arias F, Urman RD, Richman DC, Sweitzer BJ, Edwards AF, Armstrong MJ, Chopra A, Libon DJ, Price C. Common neurodegenerative disorders in the perioperative setting: Recommendations for screening from the Society for Perioperative Assessment and Quality Improvement (SPAQI). PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2020; 20:100092. [PMID: 32577538 PMCID: PMC7311090 DOI: 10.1016/j.pcorm.2020.100092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aging is associated with normal and abnormal brain and cognitive changes. Due to the expected increase in older adults requiring surgery, perioperative clinicians will be increasingly encountering patients with neurodegenerative disease. To help perioperative clinicians understand signs of abnormal behaviors that may mark an undiagnosed neurodegenerative disorder and alert additional patient monitoring, The Society for Perioperative Assessment and Quality Improvement (SPAQI) worked with experts in dementia, neuropsychology, geriatric medicine, neurology, and anesthesiology to provide a summary of cognitive and behavioral considerations for patients with common neurodegenerative disorders being evaluated at preoperative centers. Patients with neurodegenerative disorders are at high risk for delirium due to known neurochemical disruptions, medication interactions, associated frailty, or vascular risk profiles presenting risk for repeat strokes. We provide basic information on the expected cognitive changes with aging, most common neurodegenerative disorders, a list of behavioral features and considerations to help differentiate neurodegenerative disorders. Finally, we propose screening recommendations intended for a multidisciplinary team in the perioperative setting.
Collapse
Affiliation(s)
- Margaret Wiggins
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32603
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive, Gainesville, FL 32610
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - Deborah C Richman
- Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Health Sciences Center, Level 4, 101 Nicolls Road, Stony Brook, NY 11794-8480
| | - Bobbie Jean Sweitzer
- Northwestern University Feinberg School of Medicine, 251 East Huron, Chicago, IL 60611
| | - Angela F Edwards
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Melissa J Armstrong
- Norman Fixel Institute for Neurological Diseases, University of Florida, 3009 Williston Road, Gainesville, Florida 32608
- Neurology Department, University of Florida, 101 S Newell Drive, Gainesville, FL 32610
| | - Anita Chopra
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - David J Libon
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - Catherine Price
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
- Department of Anesthesiology, The University of Florida, Department of Anesthesiology, 1600 SW Archer Road PO Box 100254, Gainesville, FL 32610
| |
Collapse
|
6
|
Arias F, Wiggins M, Urman RD, Armstrong R, Pfeifer K, Bader AM, Libon DJ, Chopra A, Price CC. Rapid in-person cognitive screening in the preoperative setting: Test considerations and recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI). J Clin Anesth 2020; 62:109724. [PMID: 32018131 DOI: 10.1016/j.jclinane.2020.109724] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/08/2019] [Accepted: 01/11/2020] [Indexed: 02/01/2023]
Abstract
There are few cognitive screening tools appropriate for fast-paced settings with limited staffing, and particularly in preoperative evaluation clinics. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in neuropsychology, geriatric medicine, and anesthesiology to conduct a review of the literature and compile a comprehensive list of cognitive screening tools used within primary care and preoperative settings. This Recommendations Statement: 1. summarizes a review of the literature on existing cognitive screening tools used within preoperative settings; 2. discusses factors to consider when selecting cognitive screening tools in a preoperative environment; and 3. includes a work flow diagram to guide use of these screening measures. Methodology involved searching peer-reviewed literature for 29 cognitive screening tools which were identified from the literature that fit inclusion criteria. Of these 29, seven tests have been used in preoperative settings and are discussed. These seven had an average administration time ranging from one to ten minutes. Memory, language, and attention were the most commonly evaluated cognitive domains. Most had adequate sensitivity and specificity to detect cognitive impairment/dementia. While information on the psychometric properties of these tools is limited, the tools discussed are appropriate for lay examiners, are short in duration, and accessible for free or at a low cost. We describe factors that must be considered prior to instrument selection.
Collapse
Affiliation(s)
- Franchesca Arias
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive, PO Box 100165, Gainesville, FL 32610, United States of America; Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America; Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608, United States of America; Department of Anesthesiology, The University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610, United States of America.
| | - Margaret Wiggins
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America; Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608, United States of America.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America.
| | - Rebecca Armstrong
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America; Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608, United States of America.
| | - Kurt Pfeifer
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America.
| | - Angela M Bader
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America.
| | - David J Libon
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084, United States of America.
| | - Anita Chopra
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084, United States of America.
| | - Catherine C Price
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive, PO Box 100165, Gainesville, FL 32610, United States of America; Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603, United States of America; Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608, United States of America; Department of Anesthesiology, The University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL 32610, United States of America.
| |
Collapse
|
7
|
Arias F, Wiggins M, Urman RD, Armstrong R, Pfeifer K, Bader AM, Libon DJ, Chopra A, Price CC. Rapid In-Person Cognitive Screening in the Preoperative Setting: Test Considerations and Recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI). ACTA ACUST UNITED AC 2020; 19. [PMID: 32342018 DOI: 10.1016/j.pcorm.2020.100089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There are few cognitive screening tools appropriate for fast-paced settings with limited staffing, and particularly in preoperative evaluation clinics. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in neuropsychology, geriatric medicine, and anesthesiology to conduct a review of the literature and compile a comprehensive list of cognitive screening tools used within primary care and preoperative settings. This Recommendations Statement: 1. summarizes a review of the literature on existing cognitive screening tools used within preoperative settings; 2. discusses factors to consider when selecting cognitive screening tools in a preoperative environment; and 3. includes a work flow diagram to guide use of these screening measures. Methodology involved searching peer-reviewed literature for 29 cognitive screening tools which were identified from the literature that fit inclusion criteria. Of these 29, seven tests have been used in preoperative settings and are discussed. These seven had an average administration time ranging from one to ten minutes. Memory, language, and attention were the most commonly evaluated cognitive domains. Most had adequate sensitivity and specificity to detect cognitive impairment/dementia. While information on the psychometric properties of these tools is limited, the tools discussed are appropriate for lay examiners, are short in duration, and accessible for free or at a low cost. We describe factors that must be considered prior to instrument selection.
Collapse
Affiliation(s)
- Franchesca Arias
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive PO Box 100165, Gainesville, FL 32610
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
- Department of Anesthesiology, The University of Florida, Department of Anesthesiology, 1600 SW Archer Road PO Box 100254, Gainesville, FL 32610
| | - Margaret Wiggins
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - Rebecca Armstrong
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
| | - Kurt Pfeifer
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226
| | - Angela M Bader
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115
| | - David J Libon
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - Anita Chopra
- Department of Geriatrics and Gerontology, Department of Psychology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084
| | - Catherine C Price
- Pain Research and Intervention Center of Excellence (PRICE), 101 S. Newell Drive PO Box 100165, Gainesville, FL 32610
- Department of Clinical and Health Psychology, The University of Florida, 1225 Center Drive, Gainesville, FL 32603
- Perioperative Cognitive Anesthesia Network (PeCAN), UF Health Shands Hospital, 1600 SW Archer Road Suite 1111, Gainesville, FL 32608
- Department of Anesthesiology, The University of Florida, Department of Anesthesiology, 1600 SW Archer Road PO Box 100254, Gainesville, FL 32610
| |
Collapse
|
8
|
State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018. Br J Anaesth 2019; 123:464-478. [PMID: 31439308 DOI: 10.1016/j.bja.2019.07.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 12/20/2022] Open
Abstract
Cognitive recovery after anaesthesia and surgery is a concern for older adults, their families, and caregivers. Reports of patients who were 'never the same' prompted a scientific inquiry into the nature of what patients have experienced. In June 2018, the ASA Brain Health Initiative held a summit to discuss the state of the science on perioperative cognition, and to create an implementation plan for patients and providers leveraging the current evidence. This group included representatives from the AARP (formerly the American Association of Retired Persons), American College of Surgeons, American Heart Association, and Alzheimer's Association Perioperative Cognition and Delirium Professional Interest Area. This paper summarises the state of the relevant clinical science, including risk factors, identification and diagnosis, prognosis, disparities, outcomes, and treatment of perioperative neurocognitive disorders. Finally, we discuss gaps in current knowledge with suggestions for future directions and opportunities for clinical and translational projects.
Collapse
|