Postoperative delirium portends descent to dementia

Many elderly patients worry that their thinking will be impaired after surgery. Concerns include acute confusion in the days to weeks following surgery, as well as persistent cognitive deficits lasting months to years.¹ Both postoperative delirium (POD) and delayed neurocognitive recovery lasting months after surgery are common in older adults, but reports of non-resolving cognitive decline or neurocognitive disorders (NCDs) are inconsistent.²³ The acute onset inattention and disorganized thinking characteristic of POD often manifest between one and four days after surgery.⁴ Delayed neurocognitive recovery is a subtle NCD that typically lasts weeks to months following surgery. Although transient, both disorders can significantly impact recovery. Patients with POD have increased morbidity and mortality, longer Intensive Care Unit (ICU) stays, decreases in quality of life and are likely to be vulnerable to delayed neurocognitive recovery.⁵⁶ While the pathophysiology of delirium remains unclear, it has been linked with NCDs and dementia in non-surgical patients,⁷ and several studies have suggested that POD may be a risk factor for non-resolving minor and even major NCD (or incident dementia).⁸⁹ In this issue of the British Journal of Anaesthesia, the retrospective cohort studies by Sauër and colleagues¹⁰ and Sprung and colleagues¹¹ investigate the association between POD and persistent NCDs; the conflicting results highlight the difficulties in studying postoperative cognition.

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