Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 12:16:1292942.
doi: 10.3389/fnagi.2024.1292942. eCollection 2024.

Preoperative mild cognitive impairment as a risk factor of postoperative cognitive dysfunction in elderly patients undergoing spine surgery

Sujung Park  1   2 , Jeongmin Kim  1   2 , Yoon Ha  3   4 , Keung N Kim  3 , Seong Yi  3 , Bon-Nyeo Koo  1   2
Affiliations

Preoperative mild cognitive impairment as a risk factor of postoperative cognitive dysfunction in elderly patients undergoing spine surgery

Sujung Park et al. Front Aging Neurosci. .

Abstract

Introduction: Any persistent degree of cognitive impairment in older adults is a concern as it can progress to dementia. This study aimed to determine the incidence and risk factors for early postoperative cognitive dysfunction (POCD) in elderly patients undergoing spine surgery.

Methods: Patients were enrolled from a previous prospective observational study after screening for normal cognitive function using the Mini Mental State Examination (MMSE). Cognitive function was evaluated before surgery and at 1 week, month, and year post-surgery using MMSE and Montreal Cognitive Assessment scores (MoCA). Mild cognitive impairment (MCI) was determined using the MoCA scores adjusted for age. POCD was defined as a drop of three or more points on the MMSE 1 week post-surgery. Multivariate logistic analysis was performed to identify POCD risk factors.

Results: A total of 427 patients were included. Eighty-five (20%) had pre-existing MCI. The MCI group showed lower MoCA scores at each time point (baseline, 1 week after surgery, 1 month after surgery, 1 year after surgery) compared to the non-MCI group. Those in the MCI group had a higher rate of admission to intensive care unit after surgery, postoperative delirium, and POCD 1 week post-surgery, than those in the non-MCI group (16.5% vs. 6.7%, p = 0.008; 27.1% vs. 15.8%, p = 0.024; and 18.8% vs. 8.2%, p < 0.001, respectively). Among them, 10.3% were assessed for POCD on postoperative day 7 and self-reported poor social roles and physical functioning 1 week postoperatively.

Conclusion: Preoperative MCI was seen in ~20% of surgical patients aged >70 years. POCD was seen in ~20% of patients with pre-existing MCI, and ~ 10% of those without. Benzodiazepine use, significant comorbidities, pre-existing MCI, and depressive tendencies were risk factors for POCD.

Keywords: aged; cognitive dysfunction; delirium; neurocognitive disorders; perioperative care; postoperative cognitive complications.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Patient inclusion flow chart.
See this image and copyright information in PMC

References

    1. Arevalo-Rodriguez I., Smailagic N., Roqué-Figuls M., Ciapponi A., Sanchez-Perez E., Giannakou A., et al. . (2021). Mini-mental state examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI). Cochrane Database Syst. Rev. 2021:CD010783. doi: 10.1002/14651858.CD010783.pub3, PMID: - DOI - PMC - PubMed
    1. Au E., Thangathurai G., Saripella A., Yan E., Englesakis M., Nagappa M., et al. . (2023). Postoperative outcomes in elderly patients undergoing cardiac surgery with preoperative cognitive impairment: a systematic review and Meta-analysis. Anesth. Analg. 136, 1016–1028. doi: 10.1213/ANE.0000000000006346, PMID: - DOI - PubMed
    1. Bae J. B., Han J. W., Kwak K. P., Kim B. J., Kim S. G., Kim J. L., et al. . (2018). Impact of mild cognitive impairment on mortality and cause of death in the elderly. J. Alzheimers Dis. 64, 607–616. doi: 10.3233/JAD-171182, PMID: - DOI - PubMed
    1. Bilotta F., Doronzio A., Stazi E., Titi L., Fodale V., Di Nino G., et al. . (2010). Postoperative cognitive dysfunction: toward the Alzheimer’s disease pathomechanism hypothesis. J. Alzheimers Dis. 22, S81–S89. doi: 10.3233/JAD-2010-100825 - DOI - PubMed
    1. Carcelén-Fraile M. D. C., Llera-Delatorre A. M., Aibar-Almazán A., Afanador-Restrepo D. F., Baena-Marín M., Hita-Contreras F., et al. . (2022). Cognitive stimulation as alternative treatment to improve psychological disorders in patients with mild cognitive impairment. J. Clin. Med. 11:3947. doi: 10.3390/jcm11143947, PMID: - DOI - PMC - PubMed

LinkOut - more resources