Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St Vincent's Hospital, Victoria Parade, Melbourne, Victoria, Australia.
Best Pract Res Clin Anaesthesiol. 2011 Sep;25(3):379-93. doi: 10.1016/j.bpa.2011.05.001.
Postoperative cognitive dysfunction (POCD) was originally thought to be associated with cardiac surgery, but has since been associated with non-cardiac surgery and even sedation for non-invasive procedures such as coronary angiography. The focus of POCD has thus shifted from the type of surgery or anaesthetic to patient susceptibility. The realisation that cognitive impairment, such as mild cognitive impairment (MCI - the prodrome for Alzheimer's disease (AD)), may already exist in many elderly patients who incidentally present for surgery beckons anaesthesia to align cognitive research with that of AD in order to draw valid parallels between the two disciplines. Long-term studies are required to understand if POCD is merely a transient phenomenon, or if it is the harbinger of long-term cognitive deterioration which may lead eventually to dementia. In this regard, the use of CSF analysis to diagnose AD many years before symptoms appear may identify susceptible individuals. Furthermore, animal studies indicate that volatile anaesthestics may augment the pathological processes of AD by affecting amyloid-beta processing. Identification of a link between surgery/anaesthesia, POCD, MCI, and AD would create a unique opportunity to fast-track the development of clinical or pharmacological preventive strategies that would benefit a significant proportion of the population.
术后认知功能障碍（POCD）最初被认为与心脏手术有关，但后来与非心脏手术甚至非侵入性手术（如冠状动脉造影）的镇静有关。因此，POCD 的重点已经从手术或麻醉类型转移到了患者的易感性。人们意识到，认知障碍，如轻度认知障碍（MCI - 阿尔茨海默病（AD）的前兆），可能已经存在于许多偶然接受手术的老年患者中，这促使麻醉学将认知研究与 AD 研究相结合，以便在这两个学科之间建立有效的对比。需要进行长期研究，以了解 POCD 是否仅仅是短暂现象，还是长期认知恶化的先兆，最终可能导致痴呆。在这方面，使用脑脊液分析在症状出现多年前诊断 AD 可能会识别出易感个体。此外，动物研究表明，挥发性麻醉剂可能通过影响淀粉样蛋白-β的处理来增强 AD 的病理过程。确定手术/麻醉、POCD、MCI 和 AD 之间的联系将为快速开发临床或药物预防策略创造独特的机会，这些策略将使相当一部分人口受益。
