J Anesth Perioper Med. 2014;1(2):97-103. https://doi.org/10.24015/ebcmed.japm.2014.0015
From the 1Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; 2Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Correspondence to Dr. Niccolò Terrando at firstname.lastname@example.org.
EBCMED ID: ebcmed.japm.2014.0015 DOI: 10.24015/ebcmed.japm.2014.0015
Aim of review
Postoperative cognitive dysfunction (POCD) is a common complication following surgery, especially in the elderly population. Surgery exposes patients to extensive trauma, blood loss, and tissue injury, all of which contribute to an inflammatory response. In recent years, inflammation has been shown to be a key contributor to the pathogenesis of cognitive decline and neuroinflammatory processes, both in animal models and initial clinical observations.
We review the recent literatures on the proposed mechanisms whereby peripheral trauma leads to cognitive impairments and some of the new neuroprotective strategies that may be implemented to prevent neuroinflammation and POCD.
Changes in pro-inflammatory cytokines, alarmins, macrophage activation and blood-brain barrier (BBB) dysfunction have been proven to be related to the pathogenesis of cognitive decline using a variety of models, reagents, and technologies. Strategies to harness these pathways through anti-inflammatory and pro-resolving strategies show remarkable effects in modulating neuronal function, synaptic plasticity, glia activity and memory processes.
Further studies are needed to better identify the patients at higher risk for cognitive decline in the postoperative period and which interventions may be suitable for translation and new clinical trials.
Declaration of Interests
No other potential conflict of interest relevant to this review was reported.
The author thanks Dr. Ralph E Harding for critical reading of the manuscript and grants from the European Society of Anaesthesiology and Karolinska Institutet Foundations.
Thanks also to the collaborators and investigators contributing to this field whose publications were not cited due to size limitations.
This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.