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PSYCH up2date 2013; 7(03): 145-160
DOI: 10.1055/s-0033-1343131
Organische psychische Störungen
© Georg Thieme Verlag KG Stuttgart · New York

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

Tino Münster
,
Alexander Tzabazis
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Publikationsverlauf

Publikationsdatum:
29. April 2013 (online)

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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

  • 1 Bedford PD. Adverse cerebral effects of anaesthesia on old people. Lancet 1955; 269: 259-263
    PubMedSuche in Google Scholar
  • 2 Funder KS, Steinmetz J, Rasmussen LS. Methodological issues of postoperative cognitive dysfunction research. Semin Cardiothorac Vasc Anesth 2010; 14: 119-122
    CrossrefSuche in Google Scholar
  • 3 Hovens IB, Schoemaker RG, van der Zee EA et al. Thinking through postoperative cognitive dysfunction: How to bridge the gap between clinical and pre-clinical perspectives. Brain Behav Immun 2012; 26: 1169-1179
    CrossrefSuche in Google Scholar
  • 4 Costa LG, Aschner M, Vitalone A et al. Developmental neuropathology of environmental agents. Annu Rev Pharmacol Toxicol 2004; 44: 87-110
    CrossrefSuche in Google Scholar
  • 5 McKhann G, Drachman D, Folstein M et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984; 34: 939-944
    CrossrefPubMedSuche in Google Scholar
  • 6 Longo VG. Behavioral and electroencephalographic effects of atropine and related compounds. Pharmacol Rev 1966; 18: 965-996
    Suche in Google Scholar
  • 7 Inouye SK, van Dyck CH, Alessi CA et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113: 941-948
    CrossrefSuche in Google Scholar
  • 8 Avidan MS, Evers AS. Review of clinical evidence for persistent cognitive decline or incident dementia attributable to surgery or general anesthesia. J Alzheimers Dis 2011; 24: 201-216
    Suche in Google Scholar
  • 9 Murkin JM, Newman SP, Stump DA et al. Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. Ann Thorac Surg 1995; 59: 1289-1295
    CrossrefPubMedSuche in Google Scholar
  • 10 Silbert B, Evered L, Scott DA. Cognitive decline in the elderly: is anaesthesia implicated?. Best Pract Res Clin Anaesthesiol 2011; 25: 379-393
    CrossrefSuche in Google Scholar
  • 11 Lewis M, Maruff P, Silbert B. Statistical and conceptual issues in defining post-operative cognitive dysfunction. Neurosci Biobehav Rev 2004; 28: 433-440
    CrossrefSuche in Google Scholar
  • 12 Keizer AM, Hijman R, Kalkman CJ et al. The incidence of cognitive decline after (not) undergoing coronary artery bypass grafting: the impact of a controlled definition. Acta Anaesthesiol Scand 2005; 49: 1232-1235
    CrossrefSuche in Google Scholar
  • 13 Newman S, Stygall J, Hirani S et al. Postoperative cognitive dysfunction after noncardiac surgery: a systematic review. Anesthesiology 2007; 106: 572-590
    CrossrefSuche in Google Scholar
  • 14 Burkhart CS, Birkner-Binder D, Gagneux A et al. Evaluation of a summary score of cognitive performance for use in trials in perioperative and critical care. Dement Geriatr Cogn Disord 2011; 31: 451-459
    CrossrefSuche in Google Scholar
  • 15 Chandler MJ, Lacritz LH, Hynan LS et al. A total score for the CERAD neuropsychological battery. Neurology 2005; 65: 102-106
    CrossrefSuche in Google Scholar
  • 16 Hensel A, Angermeyer MC, Riedel-Heller SG. Measuring cognitive change in older adults. Do reliable change indices of the SIDAM predict dementia?. J Neurol 2007; 254: 1359-1365
    CrossrefSuche in Google Scholar
  • 17 Stein J, Luppa M, Maier W et al. The assessment of changes in cognitive functioning in the elderly: age- and education-specific reliable change indices for the SIDAM. Dement Geriatr Cogn Disord 2012; 33: 73-83
    CrossrefSuche in Google Scholar
  • 18 Galasko D, Bennett D, Sano M et al. An inventory to assess activities of daily living for clinical trials in Alzheimer’s disease. The Alzheimer’s Disease Cooperative Study. Alzheimer Dis Assoc Disord 1997; 11 (Suppl. 02) S33-S39
    CrossrefSuche in Google Scholar
  • 19 Lucas-Carrasco R, Skevington SM, Gomez-Benito J et al. Using the WHOQOL-BREF in persons with dementia: a validation study. Alzheimer Dis Assoc Disord 2011; 25: 345-351
    CrossrefSuche in Google Scholar
  • 20 Abildstrom H, Rasmussen LS, Rentowl P et al. Cognitive dysfunction 1–2 years after non-cardiac surgery in the elderly. ISPOCD group. International Study of Post-Operative Cognitive Dysfunction. Acta Anaesthesiol Scand 2000; 44: 1246-1251
    CrossrefSuche in Google Scholar
  • 21 Bittner EA, Yue Y, Xie Z. Brief review: anesthetic neurotoxicity in the elderly, cognitive dysfunction and Alzheimer’s disease. Can J Anaesth 2011; 58: 216-223
    Suche in Google Scholar
  • 22 Moller JT, Cluitmans P, Rasmussen LS et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet 1998; 351: 857-861
    CrossrefPubMedSuche in Google Scholar
  • 23 Newman MF, Grocott HP, Mathew JP et al. Report of the substudy assessing the impact of neurocognitive function on quality of life 5 years after cardiac surgery. Stroke 2001; 32: 2874-2881
    CrossrefSuche in Google Scholar
  • 24 Royse CF, Andrews DT, Newman SN et al. The influence of propofol or desflurane on postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery. Anaesthesia 2011; 66: 455-464
    CrossrefSuche in Google Scholar
  • 25 Steinmetz J, Christensen KB, Lund T et al. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology 2009; 110: 548-555
    CrossrefSuche in Google Scholar
  • 26 Vanderweyde T, Bednar MM, Forman SA et al. Iatrogenic risk factors for Alzheimer’s disease: surgery and anesthesia. J Alzheimers Dis 2010; 22 (Suppl. 03) 91-104
    Suche in Google Scholar
  • 27 Lee TA, Wolozin B, Weiss KB et al. Assessment of the emergence of Alzheimer’s disease following coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty. J Alzheimers Dis 2005; 7: 319-324
    Suche in Google Scholar
  • 28 Selnes OA, Royall RM, Grega MA et al. Cognitive changes 5 years after coronary artery bypass grafting: is there evidence of late decline?. Arch Neurol 2001; 58: 598-604
    CrossrefSuche in Google Scholar
  • 29 Erdogan MA, Demirbilek S, Erdil F et al. The effects of cognitive impairment on anaesthetic requirement in the elderly. Eur J Anaesthesiol 2012; 29: 326-331
    CrossrefSuche in Google Scholar
  • 30 Hudetz JA, Patterson KM, Pagel PS. Comparison of pre-existing cognitive impairment, amnesic mild cognitive impairment, and multiple domain mild cognitive impairment in men scheduled for coronary artery surgery. Eur J Anaesthesiol 2012; 29: 320-325
    CrossrefSuche in Google Scholar
  • 31 Eckenhoff RG, Johansson JS, Wei H et al. Inhaled anesthetic enhancement of amyloid-beta oligomerization and cytotoxicity. Anesthesiology 2004; 101: 703-709
    CrossrefPubMedSuche in Google Scholar
  • 32 Zhen Y, Dong Y, Wu X et al. Nitrous oxide plus isoflurane induces apoptosis and increases beta-amyloid protein levels. Anesthesiology 2009; 111: 741-752
    CrossrefSuche in Google Scholar
  • 33 Dong Y, Zhang G, Zhang B et al. The common inhalational anesthetic sevoflurane induces apoptosis and increases beta-amyloid protein levels. Arch Neurol 2009; 66: 620-631
    CrossrefSuche in Google Scholar
  • 34 Zhang B, Dong Y, Zhang G et al. The inhalation anesthetic desflurane induces caspase activation and increases amyloid beta-protein levels under hypoxic conditions. J Biol Chem 2008; 283: 11866-11875
    CrossrefSuche in Google Scholar
  • 35 Wei H, Liang G, Yang H et al. The common inhalational anesthetic isoflurane induces apoptosis via activation of inositol 1,4,5-trisphosphate receptors. Anesthesiology 2008; 108: 251-260
    CrossrefSuche in Google Scholar
  • 36 Wei H, Xie Z. Anesthesia, calcium homeostasis and Alzheimer’s disease. Curr Alzheimer Res 2009; 6: 30-35
    CrossrefSuche in Google Scholar
  • 37 Xie Z, Culley DJ, Dong Y et al. The common inhalation anesthetic isoflurane induces caspase activation and increases amyloid beta-protein level in vivo. Ann Neurol 2008; 64: 618-627
    CrossrefSuche in Google Scholar
  • 38 Jevtovic-Todorovic V, Carter LB. The anesthetics nitrous oxide and ketamine are more neurotoxic to old than to young rat brain. Neurobiol Aging 2005; 26: 947-956
    CrossrefSuche in Google Scholar
  • 39 Wan Y, Xu J, Ma D et al. Postoperative impairment of cognitive function in rats: a possible role for cytokine-mediated inflammation in the hippocampus. Anesthesiology 2007; 106: 436-443
    CrossrefSuche in Google Scholar
  • 40 Vizcaychipi MP, Lloyd DG, Wan Y et al. Xenon pretreatment may prevent early memory decline after isoflurane anesthesia and surgery in mice. PLoS One 2011; 6: e26394
    CrossrefSuche in Google Scholar
  • 41 Bianchi SL, Tran T, Liu C et al. Brain and behavior changes in 12-month-old Tg2576 and nontransgenic mice exposed to anesthetics. Neurobiol Aging 2008; 29: 1002-1010
    CrossrefSuche in Google Scholar
  • 42 Eckel B, Ohl F, Starker L et al. Effects of isoflurane-induced anaesthesia on cognitive performance in a mouse model of Alzheimer’s disease: a randomised trial in transgenic APP23 mice. Eur J Anaesthesiol 2012; 30: 1-8
    Suche in Google Scholar
  • 43 An LN, Yue Y, Guo WZ et al. Surgical trauma induces iron accumulation and oxidative stress in a rodent model of postoperative cognitive dysfunction. Biol Trace Elem Res 2013; 151: 277-283
    CrossrefSuche in Google Scholar
  • 44 He HJ, Wang Y, Le Y et al. Surgery upregulates high mobility group box-1 and disrupts the blood-brain barrier causing cognitive dysfunction in aged rats. CNS Neurosci Ther 2012; 18: 994-1002
    CrossrefSuche in Google Scholar
  • 45 Cao XZ, Ma H, Wang JK et al. Postoperative cognitive deficits and neuroinflammation in the hippocampus triggered by surgical trauma are exacerbated in aged rats. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34: 1426-1432
    CrossrefSuche in Google Scholar
  • 46 Williams-Russo P, Sharrock NE, Mattis S et al. Randomized trial of hypotensive epidural anesthesia in older adults. Anesthesiology 1999; 91: 926-935
    CrossrefSuche in Google Scholar
  • 47 Rasmussen LS, Johnson T, Kuipers HM et al. Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand 2003; 47: 260-266
    CrossrefSuche in Google Scholar
  • 48 Johnson T, Monk T, Rasmussen LS et al. Postoperative cognitive dysfunction in middle-aged patients. Anesthesiology 2002; 96: 1351-1357
    CrossrefSuche in Google Scholar
  • 49 Monk TG, Weldon BC, Garvan CW et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology 2008; 108: 18-30
    CrossrefSuche in Google Scholar
  • 50 Rohan D, Buggy DJ, Crowley S et al. Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly. Can J Anaesth 2005; 52: 137-142
    Suche in Google Scholar
  • 51 Schoen J, Husemann L, Tiemeyer C et al. Cognitive function after sevoflurane- vs propofol-based anaesthesia for on-pump cardiac surgery: a randomized controlled trial. Br J Anaesth 2011; 106: 840-850
    CrossrefSuche in Google Scholar
  • 52 Codaccioni JL, Velly LJ, Moubarik C et al. Sevoflurane preconditioning against focal cerebral ischemia: inhibition of apoptosis in the face of transient improvement of neurological outcome. Anesthesiology 2009; 110: 1271-1278
    CrossrefSuche in Google Scholar
  • 53 An J, Fang Q, Huang C et al. Deeper total intravenous anesthesia reduced the incidence of early postoperative cognitive dysfunction after microvascular decompression for facial spasm. J Neurosurg Anesthesiol 2011; 23: 12-17
    CrossrefSuche in Google Scholar
  • 54 Farag E, Chelune GJ, Schubert A et al. Is depth of anesthesia, as assessed by the Bispectral Index, related to postoperative cognitive dysfunction and recovery?. Anesth Analg 2006; 103: 633-640
    CrossrefSuche in Google Scholar
  • 55 Sieber FE, Zakriya KJ, Gottschalk A et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc 2010; 85: 18-26
    CrossrefSuche in Google Scholar
  • 56 Bijker JB, Persoon S, Peelen LM et al. Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case-control study. Anesthesiology 2012; 116: 658-664
    CrossrefSuche in Google Scholar
  • 57 Di Nino G, Adversi M, Dekel BG et al. Peri-operative risk management in patients with Alzheimer’s disease. J Alzheimers Dis 2010; 22 (Suppl. 03) 121-127
    Suche in Google Scholar
  • 58 Steiner LA. Postoperative delirium. Part 2: detection, prevention, and treatment. Eur J Anaesthesiol 2011; 28: 723-732
    CrossrefSuche in Google Scholar
  • 59 Steiner LA. Postoperative delirium. Part 1: pathophysiology and risk factors. Eur J Anaesthesiol 2011; 28: 628-636
    CrossrefPubMedSuche in Google Scholar
  • 60 Evered L, Scott DA, Silbert B et al. Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesth Analg 2011; 112: 1179-1185
    CrossrefSuche in Google Scholar
  • 61 Van Dijk D, Jansen EW, Hijman R et al. Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial. J Am Med Assoc 2002; 287: 1405-1412
    CrossrefSuche in Google Scholar
  • 62 Kruis RW, Vlasveld FA, Van Dijk D. The (un)importance of cerebral microemboli. Semin Cardiothorac Vasc Anesth 2010; 14: 111-118
    CrossrefSuche in Google Scholar
  • 63 Allan SM, Rothwell NJ. Cytokines and acute neurodegeneration. Nat Rev Neurosci 2001; 2: 734-744
    CrossrefSuche in Google Scholar
  • 64 Hein AM, O’Banion MK. Neuroinflammation and memory: the role of prostaglandins. Mol Neurobiol 2009; 40: 15-32
    CrossrefSuche in Google Scholar
  • 65 Westaby S, Saatvedt K, White S et al. Is there a relationship between cognitive dysfunction and systemic inflammatory response after cardiopulmonary bypass?. Ann Thorac Surg 2001; 71: 667-672
    CrossrefSuche in Google Scholar
  • 66 Mathew JP, Shernan SK, White WD et al. Preliminary report of the effects of complement suppression with pexelizumab on neurocognitive decline after coronary artery bypass graft surgery. Stroke 2004; 35: 2335-2339
    CrossrefSuche in Google Scholar
  • 67 Taggart DP, Browne SM, Wade DT et al. Neuroprotection during cardiac surgery: a randomised trial of a platelet activating factor antagonist. Heart 2003; 89: 897-900
    CrossrefSuche in Google Scholar
  • 68 Rasmussen LS, O’Brien JT, Silverstein JH et al. Is peri-operative cortisol secretion related to post-operative cognitive dysfunction?. Acta Anaesthesiol Scand 2005; 49: 1225-1231
    CrossrefSuche in Google Scholar
  • 69 Crosby G, Culley DJ, Hyman BT. Preoperative cognitive assessment of the elderly surgical patient: a call for action. Anesthesiology 2011; 114: 1265-1268
    CrossrefSuche in Google Scholar
  • 70 Popescu BO, Toescu EC, Popescu LM et al. Blood-brain barrier alterations in ageing and dementia. J Neurol Sci 2009; 283: 99-106
    CrossrefSuche in Google Scholar
  • 71 Petersen RC. Clinical practice. Mild cognitive impairment. N Engl J Med 2011; 364: 2227-2234
    CrossrefSuche in Google Scholar
  • 72 Bekker A, Lee C, de Santi S et al. Does mild cognitive impairment increase the risk of developing postoperative cognitive dysfunction?. Am J Surg 2010; 199: 782-788
    CrossrefSuche in Google Scholar
  • 73 Plassman BL, Langa KM, Fisher GG et al. Prevalence of cognitive impairment without dementia in the United States. Ann Intern Med 2008; 148: 427-434
    CrossrefSuche in Google Scholar
  • 74 Petersen RC, Roberts RO, Knopman DS et al. Mild cognitive impairment: ten years later. Arch Neurol 2009; 66: 1447-1455
    CrossrefPubMedSuche in Google Scholar