Review

. 2019 Oct;123(4):464-478.

doi: 10.1016/j.bja.2019.07.004. Epub 2019 Aug 19.

State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

Elizabeth Mahanna-Gabrielli¹, Katie J Schenning², Lars I Eriksson³, Jeffrey N Browndyke⁴, Clinton B Wright⁵, Deborah J Culley, Lis Evered⁶, David A Scott⁶, Nae Yah Wang⁷, Charles H Brown 4th⁷, Esther Oh⁷, Patrick Purdon⁸, Sharon Inouye⁹, Miles Berger¹⁰, Robert A Whittington¹¹, Catherine C Price, Stacie Deiner¹²

Affiliations

¹ Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
² Oregon Health & Science University, Portland, OR, USA.
³ Department of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
⁴ Geriatric Behavioral Health Division, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center and Duke Institute for Brain Sciences, Duke University, Durham, NC, USA.
⁵ National Institute of Neurological Disorders, Bethesda, MD, USA.
⁶ Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Department of Medicine, Biostatistics, and Epidemiology, Department of Anesthesiology and Critical Care Medicine, and Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁸ Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁹ Aging Brain Center at the Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, Beth Israel Deaconess, Boston, MA, USA.
¹⁰ Department of Anesthesiology, Duke Center for Cognitive Neuroscience, Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
¹¹ Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
¹² Departments of Anesthesiology, Perioperative and Pain Medicine, Geriatrics and Palliative Care, and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: stacie.deiner@mountsinai.org.

PMID: 31439308
PMCID: PMC6871269
DOI: 10.1016/j.bja.2019.07.004

Review

State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

Elizabeth Mahanna-Gabrielli et al. Br J Anaesth. 2019 Oct.

. 2019 Oct;123(4):464-478.

doi: 10.1016/j.bja.2019.07.004. Epub 2019 Aug 19.

Authors

Affiliations

¹ Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
² Oregon Health & Science University, Portland, OR, USA.
³ Department of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
⁴ Geriatric Behavioral Health Division, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center and Duke Institute for Brain Sciences, Duke University, Durham, NC, USA.
⁵ National Institute of Neurological Disorders, Bethesda, MD, USA.
⁶ Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Department of Medicine, Biostatistics, and Epidemiology, Department of Anesthesiology and Critical Care Medicine, and Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁸ Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁹ Aging Brain Center at the Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Harvard Medical School, Beth Israel Deaconess, Boston, MA, USA.
¹⁰ Department of Anesthesiology, Duke Center for Cognitive Neuroscience, Duke Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
¹¹ Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
¹² Departments of Anesthesiology, Perioperative and Pain Medicine, Geriatrics and Palliative Care, and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: stacie.deiner@mountsinai.org.

PMID: 31439308
PMCID: PMC6871269
DOI: 10.1016/j.bja.2019.07.004

Erratum in

Corrigendum to '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).
Mahanna-Gabrielli E, Schenning KJ, Eriksson LI, Browndyke JN, Wright CB, Culley DJ, Evered L, Scott DA, Wang NY, Brown CH 4th, Oh E, Purdon P, Inouye S, Berger M, Whittington RA, Price CC, Deiner S. Mahanna-Gabrielli E, et al. Br J Anaesth. 2019 Dec;123(6):917. doi: 10.1016/j.bja.2019.09.014. Epub 2019 Oct 4. Br J Anaesth. 2019. PMID: 31591017 Free PMC article. No abstract available.

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.

Keywords: anaesthesia; delirium; geriatrics; neurocognitive disorders; perioperative brain health; postoperative cognitive dysfunction; postoperative complications.

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Figures

**Fig 1**
Postoperative cognitive dysfunction and neurocognitive disorders, a crosswalk. MCI, mild cognitive impairment; POCD, postoperative cognitive dysfunction.* Where a new diagnosis is made after 12 months.

**Fig 2**
Perioperative acceleration of neuropathology. HPA, hypothalamic–pituitary–adrenal.

See this image and copyright information in PMC

Comment in

Three blind mice: a tail of discordant trials.
Whitlock EL, Avidan MS. Whitlock EL, et al. Br J Anaesth. 2020 Feb;124(2):121-125. doi: 10.1016/j.bja.2019.09.035. Epub 2019 Oct 31. Br J Anaesth. 2020. PMID: 31676036 No abstract available.

References

1. Centers for Disease Control and Prevention . 2010. Number of all-listed procedures for discharges from short-stay hospitals, by procedure category and age: United States.http://www.cdc.gov/nchs/data/nhds/4procedures/2010pro4_numberprocedureag... Available from:
1. Shaw P.J., Bates D., Cartlidge N.E. Long-term intellectual dysfunction following coronary artery bypass graft surgery: a six month follow-up study. Q J Med. 1987;62:259–268. - PubMed
1. Savage G.H. Insanity following the use of anaesthetics in operations. BMJ. 1887;2:1199–1200.
1. Rudolph J.L., Marcantonio E.R. Review articles: postoperative delirium: acute change with long-term implications. Anesth Analg. 2011;112:1202–1211. - PMC - PubMed
1. Sprung J., Roberts R.O., Weingarten T.N. Postoperative delirium in elderly patients is associated with subsequent cognitive impairment. Br J Anaesth. 2017;119:316–323. - PubMed

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State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

Affiliations

State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

Authors

Affiliations

Erratum in

Abstract

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical