Type and severity of cognitive decline in older adults after noncardiac surgery
Type and severity of cognitive decline in older adults after noncardiac surgery
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DOI：
10.1097/01.anes.0000296072.02527.18
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发表时间：
2008-01-01
期刊：
影响因子：
8.8
通讯作者：
Monk, Terri G.
中科院分区：
文献类型：
--
作者：
Price, Catherine C.;Garvan, Cynthia W.;Monk, Terri G.
背景：作者调查了老年人非心脏手术后即刻和3个月认知功能下降的类型和严重程度。工具性日常生活活动的变化进行了检查相对于类型的认知decline.Methods：在最初的417名老年人参加了这项研究，337例手术患者和60名对照完成基线，出院，和/或3个月的术后认知和工具性活动的daffy生活措施。可靠的变化方法被用来检查三种类型的认知下降：记忆，执行功能，和执行功能/记忆的组合。SD截止值被用来分级的变化，轻度，中度或severe.Results的严重程度：在出院时，186（56%）例患者经历了认知功能下降，在类型和严重程度的平等分布。术后3个月，231例患者（75.1%）未发生认知功能下降，42例（13.6%）仅显示记忆功能下降，2例（8.4%）仅显示执行功能下降，9例（2.9%）显示执行和记忆功能均下降。在认知功能下降的患者中，36例（46.8%）为轻度下降，25例（32.5%）为中度下降，16例（20.8%）为重度下降。联合组损伤更严重。执行功能或组合（记忆和执行）缺陷涉及更高水平的功能（即，工具性日常生活活动）障碍。合并组的教育程度低于未受损和记忆groups.Conclusion：术后认知表现随时间的测试。在手术后3个月，更多的老年人经历了记忆力下降，但只有那些执行或合并认知下降的人有功能限制。这些发现与患者和护理人员有关。未来的研究应探讨围手术期因素如何影响神经系统。
Background: The authors investigated type and severity of cognitive decline in older adults immediately and 3 months after noncardiac surgery. Changes in instrumental activities of daily living were examined relative to type of cognitive decline.Methods: Of the initial 417 older adults enrolled in the study, 337 surgery patients and 60 controls completed baseline, discharge, and/or 3-month postoperative cognitive and instrumental activities of daffy living measures. Reliable change methods were used to examine three types of cognitive decline: memory, executive function, and combined executive function/ memory. SD cutoffs were used to grade severity of change as mild, moderate or severe.Results: At discharge, 186 (56%) patients experienced cognitive decline, with an equal distribution in type and severity. At 3 months after surgery, 231 patients (75.1%) experienced no cognitive decline, 42 (13.6%) showed only memory decline, 2 (8.4%) showed only executive function decline, and 9 (2.9%) showed decline in both executive and memory domains. Of those with cognitive decline, 36 (46.8%) had mild, 25 (32.5%) had moderate, and 16 (20.8%) had severe decline. The combined group had more severe impairment. Executive function or combined (memory and executive) deficits involved greater levels of functional (i.e., instrumental activities of daily living) impairment. The combined group was less educated than the unimpaired and memory groups.Conclusion: Postsurgical cognitive presentation varies with time of testing. At 3 months after surgery, more older adults experienced memory decline, but only those with executive or combined cognitive decline had functional limitations. The findings have relevance for patients and caregivers. Future research should examine how perioperative factors influence neuronal systems.