Education  |   October 2018
Neurocognitive Function after Cardiac Surgery: From Phenotypes to Mechanisms
Author Notes
  • From the Department of Anesthesiology (M.B., N.T., S.K.S., M.F.N., J.P.M.) and Division of Geriatric Behavioral Health, Department of Psychiatry and Behavioral Sciences (J.N.B), Duke University Medical Center, Durham, North Carolina.
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • This is a Brain Health Initiative submission.
    This is a Brain Health Initiative submission.×
  • Submitted for publication June 2, 2017. Accepted for publication February 26, 2018.
    Submitted for publication June 2, 2017. Accepted for publication February 26, 2018.×
  • Address correspondence to Dr. Berger: Duke South Orange Zone, Room 4317, Duke University Medical Center, Durham, North Carolina 27710. miles.berger@duke.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Review Article / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Geriatric Anesthesia
Education   |   October 2018
Neurocognitive Function after Cardiac Surgery: From Phenotypes to Mechanisms
Anesthesiology 10 2018, Vol.129, 829-851. doi:10.1097/ALN.0000000000002194
Anesthesiology 10 2018, Vol.129, 829-851. doi:10.1097/ALN.0000000000002194
Abstract

For half a century, it has been known that some patients experience neurocognitive dysfunction after cardiac surgery; however, defining its incidence, course, and causes remains challenging and controversial. Various terms have been used to describe neurocognitive dysfunction at different times after cardiac surgery, ranging from “postoperative delirium” to “postoperative cognitive dysfunction or decline.” Delirium is a clinical diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Postoperative cognitive dysfunction is not included in the DSM-5 and has been heterogeneously defined, though a recent international nomenclature effort has proposed standardized definitions for it. Here, the authors discuss pathophysiologic mechanisms that may underlie these complications, review the literature on methods to prevent them, and discuss novel approaches to understand their etiology that may lead to novel treatment strategies. Future studies should measure both delirium and postoperative cognitive dysfunction to help clarify the relationship between these important postoperative complications.