Current opinion in psychiatry
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Curr Opin Psychiatry · May 2017
ReviewCognitive decline associated with anesthesia and surgery in the elderly: does this contribute to dementia prevalence?
To provide an update on the current state of research investigating the effects of anesthesia and surgery on cognition in the elderly, including consideration of overlap with cognitive disorders in the community. ⋯ Cognitive impairment in the elderly ultimately leads to a decline in function with high personal and societal costs. Following anesthesia and surgery, decline in cognition is observed in some individuals, which may represent vulnerability for future decline or may alter their cognitive trajectory. Recent work suggests factors that impact this decline and/or impair recovery include higher risk patients and subtle cognitive impairment preoperatively. Identifying these individuals is critical to determining opportunities for intervention and preventive strategies, and ultimately reducing the impact on functional decline. It remains unclear if anesthesia and surgery play a role in the onset or progression of mild cognitive impairment and dementia across the community. Recent work showing that preoperative impairment is a significant risk factor for decline indicates that routinely assessing cognition preoperatively would allow improved management including referral pathways for patients at risk, delirium prevention, specifically optimizing care and consideration of treatment options.