POCD ( Postoperative cognitive dysfunction ) is a little-known condition that affects a substantial number of older adults after surgery.
Different patients are affected in different ways. Some patients with POCD experience memory problems, difficulty multitasking, learning new things, or setting priorities.
Unlike delirium, an acute, sudden-onset disorder that affects consciousness and attention, POCD can involve difficult to recognize symptoms that develop days to weeks after surgery.
Most of the time, POCD is transient and patients get better in several months. But sometimes this condition lasts up to a year or longer.
POCD first began to be studied systematically about 20 years ago. But reports of patients who appeared cognitively compromised after surgery date back about 100 years.
An influential 1955 report in The Lancet noted common complaints by family or friends after someone dear to them had surgery: “He’s become so forgetful. … She’s lost all interest in the family. … He can’t concentrate on anything. … He’s just not the same person since.”
There is no short, simple test for POCD. Typically, a series of neuropsychological tests are administered before and after surgery, a time-consuming process. Often, tests are given one week and again three months after surgery. But the tests used and time frames differ in various studies. Studies also define POCD differently, using varying criteria to assess the kind and extent of memory decline that patients experience.
There is no short, simple test for POCD. Typically, a series of neuropsychological tests are administered before and after surgery, a time-consuming process. Often, tests are given one week and again three months after surgery. But the tests used and time frames differ in various studies. Studies also define POCD differently, using varying criteria to assess the kind and extent of cognitive impairment that patients experience.
The first international study of older adults with POCD (those age 60 and older) in 1999 suggested that about 26 percent of patients had this condition one week after a major non-cardiac surgery, such as a hip replacement. 10% had it three months after surgery.
Two years later, a study by researchers at Duke University Medical Center,published in the New England Journal of Medicine, found that 53 percent of adults who had heart bypass surgery showed significant evidence of cognitive decline when they were discharged from the hospital; 36 percent were affected at six weeks; 24 percent, at six months; and 42 percent, five years after their operations.
Another Duke study of older adults who had knee and hip replacements found that 59 percent had cognitive dysfunction immediately after surgery; 34 percent, at three months; and 42 percent, at two years.
Other studies have produced similar results. A current research project examining seniors aged 55+ who have major non-cardiac surgeries is finding that 30 percent tested significantly worse than their baseline 3 months later.
POCD after surgery increases in the aged. Adults age 60 and older are twice as likely to develop POCD than younger adults.
POCD: Causes In The Elderly
Most surgery causes peripheral inflammation. In young people, the brain remains largely isolated from that inflammation, but with older people, our blood-brain barrier becomes leaky. That contributes to neuroinflammation, which activates a whole cascade of events in the brain that can accelerate the ongoing aging process.
Seniors faced with the possibility of surgery should let their doctor know if they have any cognitive or memory problems. Alternatives to surgery may be possible.