Price Catherine C, Garvan Cynthia W, Monk Terri G
Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida 32610-0165, USA.
Anesthesiology. 2008 Jan;108(1):8-17. doi: 10.1097/01.anes.0000296072.02527.18.
The authors investigated type and severity of cognitive decline in older adults immediately and 3 months after noncardiac surgery. Changes in instrumental activities of daily living were examined relative to type of cognitive decline.
Of the initial 417 older adults enrolled in the study, 337 surgery patients and 60 controls completed baseline, discharge, and/or 3-month postoperative cognitive and instrumental activities of daily living measures. Reliable change methods were used to examine three types of cognitive decline: memory, executive function, and combined executive function/memory. SD cutoffs were used to grade severity of change as mild, moderate or severe.
At discharge, 186 (56%) patients experienced cognitive decline, with an equal distribution in type and severity. At 3 months after surgery, 231 patients (75.1%) experienced no cognitive decline, 42 (13.6%) showed only memory decline, 26 (8.4%) showed only executive function decline, and 9 (2.9%) showed decline in both executive and memory domains. Of those with cognitive decline, 36 (46.8%) had mild, 25 (32.5%) had moderate, and 16 (20.8%) had severe decline. The combined group had more severe impairment. Executive function or combined (memory and executive) deficits involved greater levels of functional (i.e., instrumental activities of daily living) impairment. The combined group was less educated than the unimpaired and memory groups.
Postsurgical cognitive presentation varies with time of testing. At 3 months after surgery, more older adults experienced memory decline, but only those with executive or combined cognitive decline had functional limitations. The findings have relevance for patients and caregivers. Future research should examine how perioperative factors influence neuronal systems.
作者调查了老年人非心脏手术后即刻及术后3个月认知功能下降的类型和严重程度。并相对于认知功能下降的类型，对日常生活工具性活动的变化进行了研究。
在最初纳入研究的417名老年人中，337名手术患者和60名对照完成了基线、出院时和/或术后3个月的认知及日常生活工具性活动测量。采用可靠变化方法来检查三种类型的认知功能下降：记忆、执行功能以及执行功能/记忆合并型。使用标准差临界值将变化的严重程度分为轻度、中度或重度。
出院时，186名（56%）患者出现认知功能下降，在类型和严重程度上分布均匀。术后3个月时，231名患者（75.1%）未出现认知功能下降，42名（13.6%）仅表现为记忆下降，26名（8.4%）仅表现为执行功能下降，9名（2.9%）在执行和记忆领域均出现下降。在出现认知功能下降的患者中，36名（46.8%）为轻度下降，25名（32.5%）为中度下降，16名（20.8%）为重度下降。合并组的损伤更严重。执行功能或合并（记忆和执行）缺陷涉及更高水平的功能（即日常生活工具性活动）损伤。合并组的受教育程度低于未受损组和记忆组。
术后认知表现随测试时间而变化。术后3个月时，更多老年人出现记忆下降，但只有那些存在执行或合并认知功能下降的患者存在功能受限。这些发现对患者和护理人员具有重要意义。未来的研究应探讨围手术期因素如何影响神经系统。
