Amirpour Anahita, Bergman Lina, Markovic Gabriela, Liander Karin, Nilsson Ulrica, Eckerblad Jeanette
Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
BMJ Open. 2025 Jan 28;15(1):e093872. doi: 10.1136/bmjopen-2024-093872.
Delayed neurocognitive recovery, previously known as postoperative cognitive dysfunction, is a common complication affecting older adults after surgery. This study aims to address the knowledge gap in postoperative neurocognitive recovery by exploring the relationship between subjective experiences, performance-based measurements, and blood biomarkers.
Mixed-methods study with a convergent parallel (QUAL+quan) design.
The study reports results from 40 older adult patients (52.5% women; mean age 73, SD 6.7) scheduled for total hip arthroplasty at a hospital in Sweden.
Neurocognitive performance was assessed using a standardised test battery, neuroinflammation through blood biomarker analysis and postoperative neurocognitive recovery via semistructured interviews and the Swedish Quality of Recovery questionnaire.
Five patients were classified as having delayed neurocognitive recovery based on performance tests. Qualitative data revealed that most patients reported cognitive symptoms, particularly related to executive functions and fatigue. Psychological factors, including a sense of agency and low mood, significantly influenced cognitive recovery and daily functioning. Elevated inflammatory blood biomarkers were not detected pre- or postoperatively in patients with delayed neurocognitive recovery. The global postoperative recovery score was 40.9, indicating a low quality of recovery.
Many patients reported subjective cognitive decline that was not corroborated by delayed neurocognitive recovery in the performance-based tests. Psychological factors were influential for neurocognitive recovery and should be routinely assessed. Future research should incorporate longitudinal follow-ups with performance-based measurements, fatigue assessment, evaluations of instrumental activities of daily living and subjective reporting, supported by a multidisciplinary team approach.
NCT05361460.
延迟神经认知恢复，以前称为术后认知功能障碍，是影响老年人术后的常见并发症。本研究旨在通过探索主观体验、基于表现的测量方法和血液生物标志物之间的关系，填补术后神经认知恢复方面的知识空白。
采用聚合平行（QUAL+quan）设计的混合方法研究。
该研究报告了瑞典一家医院40例计划进行全髋关节置换术的老年患者（52.5%为女性；平均年龄73岁，标准差6.7）的结果。
使用标准化测试组合评估神经认知表现，通过血液生物标志物分析评估神经炎症，并通过半结构化访谈和瑞典恢复质量问卷评估术后神经认知恢复情况。
根据表现测试，5例患者被归类为有延迟神经认知恢复。定性数据显示，大多数患者报告有认知症状，特别是与执行功能和疲劳有关的症状。心理因素，包括自主感和情绪低落，对认知恢复和日常功能有显著影响。延迟神经认知恢复的患者术前和术后均未检测到炎症性血液生物标志物升高。术后总体恢复评分为40.9，表明恢复质量较低。
许多患者报告有主观认知下降，但基于表现的测试中延迟神经认知恢复并未证实这一点。心理因素对神经认知恢复有影响，应常规评估。未来的研究应纳入基于表现的测量、疲劳评估、日常生活工具性活动评估和主观报告的纵向随访，并采用多学科团队方法提供支持。
NCT05361460。
