Cognition after major surgery in the elderly: test performance and complaints

J.B. Dijkstra*, P.J. Houx, J. Jolles

*Corresponding author for this work

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    There is evidence that older people in particular have a higher risk of cognitive dysfunction
    after surgery under general anaesthesia. We have investigated the severity and character of
    postoperative cognitive dysfunction after major non-cardiac surgery in patients older than
    65 yr. Also, cognitive complaints were studied. Cognitive function was assessed using cognitive
    tests measuring memory and attention, such as ability to shift between two sequences, ability
    to ward off distractions, simple cognitive speed and speed of general information processing.
    These tests were performed before, 1 week (short-term) and 3 months (long-term) after
    surgery. Cognitive performance of the patients was compared with that of healthy subjects
    not undergoing surgery who were also subjected to repeated cognitive measurements. After
    1 week, patients had a poorer performance on tests measuring simple cognitive speed and
    speed of general information processing. Three months after surgery, patients and controls
    showed improved cognitive performance compared with the first measurement. These results
    suggest that major non-cardiac surgery in older patients causes short-term but not long-term
    cognitive dysfunction. However, after 6 months, 14 of 48 patients (29%) reported having
    experienced a decline in cognitive abilities after discharge from hospital. Eight of these 14
    patients (17%) were still experiencing these cognitive complaints and reported ‘not being the
    same since the operation’. These findings emphasize that cognitive complaints after major
    surgery may not reflect actual changes in cognitive performance but may be caused by other
    factors such as depression or awareness of age-related changes.
    Original languageEnglish
    Pages (from-to)867-874
    Number of pages8
    JournalBritish Journal of Anaesthesia
    Issue number6
    Publication statusPublished - 1 Jan 1999

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