Xu Xuhua, Chen Zhiya, Gao Feng
Department of Neurology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China.
State Key Laboratory of Membrane Biology, School of Life Sciences, Peking University, Beijing, China.
J Alzheimers Dis. 2025 Jan;103(1):56-67. doi: 10.1177/13872877241298974. Epub 2024 Nov 29.
Postoperative cognitive dysfunction (POCD) is a common complication in elderly patients, and cerebral small vessel disease (CSVD) has been suggested as a potential risk factor. This review examines the relationship between POCD and CSVD from epidemiological, pathophysiological, and clinical perspectives, while also considering the role of Alzheimer's disease (AD) pathology. We conducted a comprehensive literature search of major databases, supplemented by reference list checking, to ensure a thorough review of studies published between 2000 and 2023 on the relationship between POCD and CSVD. Epidemiological studies have shown that POCD and CSVD are associated in terms of common risk factors, including advanced age, vascular comorbidities, impaired baseline cognitive function, and certain population characteristics. Animal studies have revealed that CSVD and POCD share similar neuropathological changes, including abnormal cerebral hypoperfusion, inflammatory responses, and blood-brain barrier disruption. Furthermore, recent research suggests a complex interplay between CSVD, AD pathology, and POCD, with potential synergistic effects on cognitive decline. Neuroimaging studies have further demonstrated that preoperative CSVD burden and postoperative CSVD progression are associated with the development of POCD, and the presence of both CSVD and AD markers may increase the risk of cognitive decline. The association between CSVD and POCD has important implications for the perioperative management of elderly patients, including preoperative assessment, choice of anesthesia and surgical methods, intraoperative management, postoperative care, and long-term follow-up. A better understanding of the relationship between CSVD and POCD will guide evidence-based strategies to prevent and manage this debilitating complication in the aging population.
术后认知功能障碍（POCD）是老年患者常见的并发症，脑小血管疾病（CSVD）被认为是一个潜在的危险因素。本综述从流行病学、病理生理学和临床角度探讨POCD与CSVD之间的关系，同时也考虑阿尔茨海默病（AD）病理学的作用。我们对主要数据库进行了全面的文献检索，并辅以参考文献列表检查，以确保对2000年至2023年发表的关于POCD与CSVD关系的研究进行全面回顾。流行病学研究表明，POCD和CSVD在共同危险因素方面存在关联，包括高龄、血管合并症、基线认知功能受损以及某些人群特征。动物研究显示，CSVD和POCD具有相似的神经病理变化，包括异常的脑灌注不足、炎症反应和血脑屏障破坏。此外，最近的研究表明CSVD、AD病理学和POCD之间存在复杂的相互作用，对认知衰退可能具有潜在的协同效应。神经影像学研究进一步证明，术前CSVD负担和术后CSVD进展与POCD的发生有关，同时存在CSVD和AD标志物可能会增加认知衰退的风险。CSVD与POCD之间的关联对老年患者的围手术期管理具有重要意义，包括术前评估、麻醉和手术方法的选择、术中管理、术后护理以及长期随访。更好地理解CSVD与POCD之间的关系将指导基于证据的策略，以预防和管理老年人群中这种使人衰弱的并发症。
