Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 23 , ISSUE S2 ( June (Supplement-2), 2019 ) > List of Articles


Postoperative Cognitive Dysfunction

Keywords : Anesthesia, Cognitive dysfunction, Neurocritical care, Postoperative period

Citation Information : Postoperative Cognitive Dysfunction. Indian J Crit Care Med 2019; 23 (S2):162-164.

DOI: 10.5005/jp-journals-10071-23196

License: CC BY-NC 4.0

Published Online: 01-06-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Cognitive dysfunction is a common complication in primary or metastatic brain tumors and can be correlated to disease itself or various treatment modalities. The symptoms of cognitive deficits may include problems with memory, attention and information processing. Primary brain tumors are highly associated with neurocognitive deficit and poor quality of life. This review discusses the pathophysiology, risk factors and assessment of cognitive dysfunction. It also gives an overview of the effect of anesthetics on postoperative cognitive dysfunction and its management.

PDF Share
  1. Goldstein B, Armstrong CL, John C, Tallent EM. Attention in adult intracranial tumors patients. J Clin Exp Neuropsyc. 2003; 25: 66.78.
  2. Crossen JR, Garwood D, Glatstein E, Neuwelt EA. Neurobehavioral sequelae of cranial irradiation in adults: a review of radiation-induced encephalopathy. J Clin Oncol 1994; 12: 627.642.
  3. Hahn CA, Dunn RH, Logue PE, King JH, Edwards CL, Halperin EC. Prospective study of neuropsychologic testing and quality-of-life assessment of adults with primary malignant brain tumors. Int J Radiat Oncol Biol Phys. 2003;55: 992.999.
  4. Scheibel RS, Meyers CA, Levin VA. Cognitive dysfunction following surgery for intracerebralglioma: influence of histopathology, lesion location, and treatment. J Neurooncol. 1996;30: 61.69.
  5. Taphoorn MJ, Klein M. Cognitive deficits in adult patients with brain tumors. The Lancet Neurology. 2004; 3:159.168.
  6. Taphoorn MJ, Schiphorst AK, Snoek FJ, Lindeboom J, Wolbers JG, Karim AB et al. Cognitive functions and quality of life in patients with low-grade gliomas: the impact of radiotherapy. Ann Neurol. 1994;36: 48.54.
  7. Rothrock RJ, Steinberger JM, Badgery H, Hecht AC, Cho SK, Caridi JM et al, Frailty status as a predictor of 3-month cognitive and functional recovery following spinal surgery: a prospective pilot study. The Spine Journal. 2019; 19: 104.112.
  8. Veeramuthu V, Narayanan V, Kuo TL, Delano-Wood L, Chinna K, Bondi MW, et al. Diffusion tensor imaging parameters in mild traumatic brain injury and its correlation with early neuropsychological impairment: a longitudinal study. J Neurotrauma. 2015; 32:1497.1509.
  9. Comerford VE, Geffen GM, May C, Medland SE, Geffen LB. A rapid screen of the severity of mild traumatic brain injury. J Clin Exp Neuropsychol. 2002 24:409.419.
  10. McCauley RL, Wilde EA, Barnes A, Hanten G, Hunter JV, Levin HS, et al. Patterns of early emotional and neuropsychological sequelae after mild traumatic brain injury. J Neurotrauma. 2014; 31:914.925.
  11. Sivak S, Bittsansky M, Grossmann J, Nosal V, Kantorova E, Sivakova J, et al. Clinical correlations of proton magnetic resonance spectroscopy findings in acute phase after mild traumatic brain injury. Brain Inj. 2014; 28:341.346.
  12. Evered L, Scott DA, Silbert B, Maruff P, et al. Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesth Analg 2011;112:1179.1185.
  13. Savageau JA, Stanton BA, Jenkins CD, Klein MD. Neuropsychological dysfunction following elective cardiac operation. 1. Early assessment. J Thorac Cardiovasc Surg. 1982; 84: 585.594.
  14. Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J et al. Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. Lancet.1998; 351: 857.861.
  15. Inouye S. Delirium in older persons. N Engl J Med. 2006;354:1157.1165.
  16. Steiner LA. Postoperative delirium. Part 1:pathophysiology and risk factors. Eur J Anaesthesiol. 2011;28:628.636.
  17. Rudolph JL, Ramlawi B, Kuchel GA, McElhaney JE, Xie D, Sellke FW et al. Chemokines are associated with delirium after cardiac surgery. J Gerontol. 2008;63:184.189.
  18. Talke P, Caldwell JE, Brown R, Dodson B, Howley J, Richardson CA. A comparison of three anesthetic techniques in patients undergoing craniotomy for supratentorial intracranial surgery. Anesth. Analg. 2002; 95: 430.435.
  19. Ali Z, Prabhakar H, Bithal PK, Dash HH. Bispectral index-guided administration of anesthesia for transsphenoidal resection of pituitary tumors: acomparison of 3 anesthetictechniques. J Neurosurg Anesthesiol. 2009 ;21:10.15.
  20. Fredriksson A, Ponten E, Gordh T, Eriksson P. Neonatal exposure to a combination of N-methyl-d-aspartate and gamma-aminobutyric acid type A receptor anesthetic agents potentiates apoptotic neurodegeneration and persistent behavioral deficits. Anesthesiology. 2007;107:427.436.
  21. Dressler I, Fritzsche T, Cortina K, Pragst F, Spies C, Rundshagen I. Psychomotor dysfunction after remifentanil/propofol anaesthesia. Eur J Anaesthesiol. 2007;24:347.354.
  22. Magni G, Baisi F, Rosa IL, Imperiale C, Fabbrini V, Pennacchiotti ML, Rosa G. No difference in emergence time and early cognitive function between sevoflurane-fentanyl and propofol-remifentanil in patients undergoing craniotomy for supratentorial intracranial surgery. J Neurosurg Anesthesiol. 2005;17:134.138.
  23. Rasmussen LS, Schmehl W, Jakobsson J. Comparison of xenon with propofol for supplementary general anaesthesia for knee replacement: a randomized study. British Journal of Anaesthesia.2006; 97: 154.159.
  24. Coburn M, Baumert JH, Roertgen D, Thiel V, Fries M, Hein M et al. Emergence and early cognitive function in the elderly after xenon or desflurane anaesthesia: a double-blinded randomized controlled trial. British Journal of Anaesthesia. 2007; 98: 756.762.
  25. Cremer J, Stoppe C, Fahlenkamp AV, Schalte G, Rex S, Rossaint R et al. Early cognitive function, recovery and well-being after sevoflurane and xenon anaesthesia in the elderly: a double-blinded randomized controlled trial. Med Gas Res. 2011; 1: 9.
  26. Fines DP, Severn AM. Anaesthesia and cognitive disturbance in the elderly. Contin Educ Anaesth Crit Care Pain 2006;6:37.40.
  27. Zou YQ, Li XB, Yang ZX, Zhou JM, Wu YN, Zhao ZH et al. Impact of inhalational anesthetics on postoperative cognitive function. Study protocol of a systematic review and meta-analysis. Medicine (Baltimore). 2018; 97: e9316.
  28. Wan Y, Xu J, Meng F, Bao Y, Ge Y, Lobo N et al. Cognitive decline following major surgery is associated with gliosis, beta-amyloid accumulation, and tau phosphorylation in old mice. Crit Care Med. 2010; 38: 190.198.
  29. Dong Y, Zhang G, Zhang B, Moir RD, Xia W, Marcantonio ER, et al. The common inhalational anestheticsevoflurane induces apoptosis and increases beta a Amyloid protein levels. Arch Neurol. 2009; 66: 620.631.
  30. Run X, Liang Z, Gong CX. Anesthetics and tau protein: animal model studies. J Alzheimer Dis. 2010; 22: S49-S55.
  31. Sanfilippo M, Shousha AWAS, Paparazzo A. Emergence in Elderly Patient Undergoing General Anesthesia with Xenon. Case Rep Anesthesiol. 2013; 2013: 736.790.
  32. Miller D, Lewis SR, Pritchard MW, Schofield-Robinson OJ, Shelton CL, Alderson P et al. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD012317.
  33. Punjasawadwong Y, Chau-in W, Laopaiboon M, Punjasawadwong S, Pin-on P. Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD011283.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.