Long term cognitive dysfunction in older people after non-cardiac surgery

doi:10.1136/bmj.328.7432.120

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ comment articles:

From

Limit by

Our online table of contents is updated at least twice each day. Read all articles published in the last 7 days.
Keep up to date with cardiology: Access the latest cardiovascular medicine resources from across BMJ Group.
The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
OPEN ACCESS: All research articles are freely available online, with no word limit. Find out more about the BMJ's open access policy. Submit your paper.
Countdown to London 2012: BMJ Group's Olympics portal highlights latest Olympics and sports medicine-themed research, comment and learning

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Amber Selwood, specialist registrar in old age psychiatry (a.selwood@ucl.ac.uk)1,
Martin Orrell, reader in psychiatry of ageing (m.orrell@ucl.ac.uk)2

¹Department of Psychiatry and Behavioural Sciences, University College London, London W1N 8AA
²Department of Psychiatry and Behavioural Sciences, University College London, London W1N 8AA

Outcomes from various studies differ, and no definite conclusion is possible

Half of all people reaching the age of 65 subsequently have one or more operations,1 but despite substantial research on short term cognitive dysfunction within the first week after the operation little research has been undertaken into the potential long term effects on cognition. The exception is cardiac surgery, where cognitive dysfunction has been well documented and has usually been attributed to the adverse effects of cardiopulmonary bypass on the brain.2 3 Various risk factors for long term (defined as three months or more) postoperative cognitive dysfunction have been investigated, including type of anaesthetic agent, general versus regional anaesthesia, use of anticholinergic agents such as atropine, or the physiological effects of the anaesthetic such as hypoxia, hypotension, or hyper-ventilation.

The multicentre International Study of Post-Operative Cognitive Dysfunction (ISPOCD1) compared 1218 patients aged 60 years and older undergoing major surgery with a control group (n = 321) of a similar age.4 At three months after …