Newswise — October 17, 2018 – An international working group has proposed a new set of terms to better describe and define cognitive changes related to surgery and anesthesia in older adults. The new consensus document has been simultaneously published by Anesthesia & Analgesia and five other international specialty journals.
The statement recommends perioperative cognitive disorders as the general term to describe cognitive impairment identified around the time of anesthesia and surgery in older adults. Additional terms are proposed to define and describe change in cognitive function before and after surgery, including the course of recovery. Lisbeth A. Evered, PhD, of St. Vincent's Hospital, Melbourne, Fitzroy, Victoria, Australia is Chair of the Nomenclature Consensus Working Group, which consists of more than 40 world experts in anesthesia, neurology, psychiatry, gerontology, and neuropsychiatry.
Proposed Terms Reflect Evolution of Thinking on Cognitive Change After Surgery
Cognitive change affecting patients after anesthesia and surgery – particularly in the elderly – has long been recognized, and has been the topic of intensive study since the 1980s. The concept of "postoperative cognitive dysfunction" (POCD) was introduced to describe subtle cognitive changes among older adults in the postoperative period, which may not be apparent unless assessed by neuropsychological testing.
Research has consistently shown declines in cognitive function in the short term (seven days) and medium term (one to three months) after anesthesia and surgery. But research in this area has occurred apart from research on cognitive functioning in the general population. The need for a formal classification reflects the high and rising numbers of older adults undergoing anesthesia and surgery and the high rates of cognitive impairment and dementia in the community, as well as the need for consistency with the diagnostic criteria and terminology used to describe other neurocognitive disorders.
The Working Group followed a consensus process to develop updated terminology to refer to cognitive change associated with anesthesia and surgery. Perioperative neurocognitive disorders is recommended as an "overarching term" for cognitive impairment identified either before or after surgery. Other terms are proposed to describe the patient's individual condition in more detail, including:
- Pre-existing cognitive impairment – referring to patients with subtle but measurable cognitive impairment before surgery
- Postoperative delirium – specifying anesthesia and surgery as a "potential precipitating cause" of delirium (confusion, altered awareness, or altered thoughts) up to one week after surgery, or while the patient is still in the hospital
- Delayed neurocognitive recovery – describing cognitive decline diagnosed up to 30 days after surgery
- Postoperative neurocognitive disorder – referring to cognitive decline that is still present up to 12 months after surgery
A key consideration in in developing the new terminology was consistency with accepted classifications of neurocognitive disorders widely used in research and clinical practice – particularly the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) nomenclature. This has important implications for clinical management of perioperative neurocognitive disorders, taking into account the patient's subjective complaint; objective evidence of cognitive impairment or change, based on standard assessments; and the impact on the patient's daily activities.
The Working Group statement has been simultaneously published in British Journal of Anaesthesia, Anesthesiology, Anesthesia & Analgesia, Canadian Journal of Anesthesia, Acta Anaesthesiologica Scandinavica, and Journal of Alzheimer's Disease. Dr. Evered and coauthors write, "This clinical nomenclature will offer a framework for understanding the impact of anesthesia and surgery on outcomes, care, and management for the elderly and thereby enhance consistency of communication and reporting."
Anesthesia & Analgesia is published in the Lippincott portfolio by Wolters Kluwer.
View the article in Anesthesia & Analgesia.
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About Anesthesia & Analgesia
Anesthesia & Analgesia was founded in 1922 and was issued bi-monthly until 1980, when it became a monthly publication. A&A is the leading journal for anesthesia clinicians and researchers and includes more than 500 articles annually in all areas related to anesthesia and analgesia, such as cardiovascular anesthesiology, patient safety, anesthetic pharmacology, and pain management. The journal is published on behalf of the IARS by Lippincott Williams & Wilkins (LWW), a division of Wolters Kluwer Health.
About the IARS
The International Anesthesia Research Society is a nonpolitical, not-for-profit medical society founded in 1922 to advance and support scientific research and education related to anesthesia, and to improve patient care through basic research. The IARS contributes nearly $1 million annually to fund anesthesia research; provides a forum for anesthesiology leaders to share information and ideas; maintains a worldwide membership of more than 15,000 physicians, physician residents, and others with doctoral degrees, as well as health professionals in anesthesia related practice; sponsors the SmartTots initiative in partnership with the FDA; supports the resident education initiative OpenAnesthesia; and publishes two journals, Anesthesia & Analgesia and A&A Case Reports.
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