Postoperative cognitive dysfunction (POCD) is a common and often underdiagnosed condition affecting elderly patients, characterized by cognitive decline after surgery, particularly following major operations like cardiac and orthopedic surgeries. The condition is linked to neuroinflammation, anesthesia effects, and patient-specific risk factors such as age and pre-existing health issues. Preventative strategies include preoperative cognitive screenings and careful management of anesthesia, while post-surgical care involves cognitive rehabilitation and a multidisciplinary approach to patient support.

1. POSTOPERATIVE COGNITIVE
DYSFUNCTION IN ELDERLY PATIENTS
Presented by Sumesh
Kassie
Date: 23/09/24

2. INTRODUCTION TO POCD
What is POCD?
- Cognitive decline after surgery.
- Affects memory, attention, and problem-solving abilities.
Why it’s important:
- Common in elderly patients.
- Can impact recovery, quality of life, and increase healthcare costs.

3. HISTORY

4. PREVALENCE OF POCD
Higher incidence in patients over 60 years old.
Frequently seen after major surgeries, such as:
- Abdomino-pelvic surgery.
- Orthopedic surgeries (e.g., hip replacement).
- Cardiac Surgery – Highest incidence.

5. PATHOPHYSIOLOGY OF POCD
Neuroinflammation: Surgery can trigger an inflammatory response
that affects the brain.
Effects of anesthesia: Both general and regional anesthesia impact
brain function.
Oxidative stress: Surgery may cause oxidative damage, especially in
elderly patients.

6. RISK FACTORS FOR POCD
Patient-specific factors:
- Age (especially 60+)
- Pre-existing conditions (dementia, diabetes, hypertension)
Surgery-related factors:
- Major surgeries (cardiac, orthopedic, vascular)
- Prolonged surgical time
Anesthesia-related factors:
- General anesthesia may carry higher risks than regional anesthesia.

7. SIGNS AND SYMPTOMS OF POCD
Cognitive domains affected:
- Memory loss
- Difficulty concentrating
- Impaired problem-solving and executive function
Onset: Typically occurs days to weeks post-surgery.
Duration: Can persist for weeks to months, sometimes longer.

8. POCD VS DELIRIUM
Delirium:
- Acute onset, fluctuating symptoms, often resolves quickly.
POCD:
- Subtle cognitive decline, with more stable and long-lasting
symptoms.

9. DIAGNOSIS AND ASSESSMENT
Screening Tools:
- Mini-Mental State Examination (MMSE)
- Montreal Cognitive Assessment (MoCA)
Family and caregiver reports: Families often notice cognitive changes
before the clinical team.
Importance of preoperative cognitive screening: Identifies high-risk
patients for POCD.

10. PREVENTION STRATEGIES
Preoperative:
- Cognitive screening and optimizing medical management (e.g.,
managing hypertension and diabetes).
Intraoperative:
- Choice of anesthetic: Regional anesthesia may reduce risk.
- Monitoring depth of anesthesia: Avoid deep sedation when possible.
Postoperative:
- Early mobilization
- Effective pain management
- Avoiding polypharmacy

12. MANAGEMENT OF POCD
Post-surgical care:
- Cognitive rehabilitation exercises (e.g., memory tasks, mental
exercises).
Multidisciplinary approach: Collaboration between doctors, nurses,
and therapists.
Family support: Educate families about the condition and offer
guidance on how to assist during recovery.

13. ROLE OF NURSES AND DOCTORS
Monitoring: Close observation for changes in cognitive function post-
surgery.
Early detection: Quick identification of cognitive decline can lead to
better management.
Communication with family: Engage families and encourage them to
report any cognitive changes in the patient.
Multidisciplinary collaboration: Coordination between doctors, nurses,
and therapists.

14. CONCLUSION
Key Takeaways:
- POCD is common and underdiagnosed in elderly patients.
- Early detection and preventative strategies are crucial.
- Multidisciplinary teams improve outcomes for patients with POCD.

15. QUESTIONS AND DISCUSSION