Somatische Intervention und Demenz – Einfluss von Chirurgie und Anästhesie auf kognitive Funktionen

Kernaussagen

POCD bezeichnet eine subtile Störung der kognitiven Leistung nach Operationen oder diagnostischen Prozeduren. Sie tritt mit zunehmendem Alter häufiger auf und führt zu einer erhöhten Mortalität, einer verminderten Lebensqualität und verursacht hohe soziökonomische Kosten.

Für die Diagnose der POCD stehen keine einheitlichen Testverfahren zur Verfügung. Die Inzidenz wird daher schwankend zwischen 10 und 70 % unmittelbar postoperativ angegeben, allerdings sind in den meisten Fällen nach 12 Monaten keine Einschränkungen mehr nachweisbar. Patienten mit vorbestehender kognitiver Leistungsminderung sind häufiger betroffen. Ein Zusammenhang mit der Entstehung einer Demenz ist aber bisher nicht nachgewiesen.

Die pathophysiologischen Mechanismen sind ungeklärt. Anästhetika oder die Art der Narkose haben keinen entscheidenden Einfluss, ebenso ist die Art des operativen Eingriffs eher sekundär. Die kognitive Reserve des einzelnen Patienten scheint aber einen entscheidenden Stellenwert für das Entstehen einer POCD darzustellen.

Therapiemöglichkeiten sind bisher nicht bekannt. Möglicherweise könnte die Einführung von körperlichen und geistigen Trainingsprogrammen positiv wirken.

• Literatur

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