Introducing DPEP program, our comprehensive online resource for patient education and empowerment. We recognize and emphasize the importance of patient engagement and believe that well-informed patients are better equipped to make informed decisions about their health and play an active role in their care. Our goal is to empower our patients with the knowledge and tools necessary to make well-informed decision and take control of their health.
What are Perioperative Neurocognitive Disorders?
Anesthesia or surgery can affect an individual’s cognition, or, thinking and memory. Perioperative Neurocognitive Disorders (PNDs) are changes to a person’s behaviour or cognition that can occur either before or after surgery.
Types of Perioperative Neurocognitive Disorders
Postoperative Delirium
A state of confusion in the first 7 days after surgery.
Definition: A disturbance of consciousness, perception, memory, and orientation, which fluctuates throughout the day.
Symptoms:
- Trouble with thinking and attention
- Agitation or sleepiness
Diagnosis: The Confusion Assessment Method is used to diagnose delirium.
Delayed Neurocognitive Recovery
A decline in cognition lasting up to 30 days after surgery.
Definition: A decline in cognitive function without delirium.
Symptoms:
- Memory impairments
- Reduced psychomotor skills
Postoperative Neurocognitive Disorder
A decline in memory and thinking lasting up to 12 months after surgery.
Definition: Any new cognitive impairment that exceeds the expected recovery period and/or lasts up to 12 months after surgery. There is typically no effect on consciousness, orientation, or attention.
Symptoms:
- Memory impairments
- Difficulty with combining tasks
- Reduced psychomotor skills
Mild vs Major:
- In mild cases, daily function is maintained
- In major cases, daily function is not maintained
Neurocognitive Disorder
A decline in cognition occurring more than 12 months after surgery.
Definition: Any cognitive impairment that persists after one year. This includes both dementia (major) and cognitive impairment (mild).
Symptoms:
- Long-term loss of brain function (mild cognitive impairment)
- Severe, short-term loss of brain function (delirium, agitation and confusion)
Diagnosis: Periodic, regular cognitive assessment using validated neurocognitive tests that demonstrate decrease in function beyond that expected.
Please contact your family doctor if you have concerns about your cognition.
What is post-operative cognitive dysfunction?
A state in which a patient’s memory and learning declines after surgery. Post-operative Cognitive Dysfunction is common:
- 1 in 3 patients will have cognitive dysfunction after leaving the hospital.
- 1 in 10 patients will have cognitive dysfunction that lasts up to 3 months after surgery.
Common symptoms include:
- Difficulty with memory and recall.
- Difficulty completing tasks that were previously not difficult.
- Struggles with multitasking.
- Reduced movement and coordination.
- Difficulty following conversations.
- Struggles with understanding speech.
Who does it effect?
Although the exact cause is unknown, some patients, who are 60 years of age or older, are at a higher risk due to pre-existing factors including:
- Health conditions including: diabetes, sleep apnea, cardiovascular diseases, pulmonary diseases, etc.
- Cognitive impairments such as: trouble remembering, concentrating, learning new things, or making decisions.
- Depression, mood disorders, or other psychiatric conditions.
- Sleep deprivation (inadequate quality or quantity of sleep).
- History of alcohol or substance abuse.
- Level of education.
How to reduce the risk of post-operative cognitive dysfunction?
- Try to exercise regularly to stay physically active.
- Maintain good eating habits & ensure proper nutrition
- Regular mental stimulation can help you maintain a healthy mind.
- Take prescribed medication regularly.
- Good management of pre-existing health conditions is important prior to any surgical procedure.
What is Post-Operative Delirium?
Post-operative delirium is a state of confusion that can happen after surgery. Certain pre-existing factors can increase your risk of developing delirium. For example, patients with pre-existing cognitive impairments are at a 2-3 times higher risk of developing delirium after surgery.
Why should you take a cognitive test before surgery?
Testing your brain before surgery can help identify your baseline mental status. This makes diagnosing delirium easier. Some example tests are shown below:
- Montreal Cognitive Assessment(MoCA): The MoCA is a free cognitive assessment tool free that can help you determine if you are of high-risk for PND.
- Short Orientation Concentration and Memory Test (S-OMCT): The S-OMCT is a short memory test that your health-care team will provideover the phone. It takes 5 minutes to complete.
- CogniFit: CogniFit is a brain training smartphone application designed to improve memory and concentration. To download, search for this application in the app store on your smartphone or tablet.
- Elevate Brain Training: Elevate is a brain training app that helps improve focus, speed, and memory. To download, search for this application in the app store on your smartphone or tablet.