Obesity and Postoperative Cognitive Dysfunction: A Curious Association

Postoperative cognitive dysfunction (POCD) is a medical condition that impacts cognitive function after surgery, particularly major procedures. Patients with POCD may experience physical symptoms, such as depression, anxiety, and fatigue, severely undermining their quality of life. Research establishes the connection between obesity and cognitive dysfunction since patients diagnosed with obesity are more susceptible to cognitive decline. Although obesity poses a significant risk factor for cognitive impairment, the link between obesity and POCD is still inadequately understood. Therefore, this systematic review explores the correlation between obesity and POCD by detailing potential mechanisms underlying this relationship and identifying areas for further research. Following the guidelines for systematic reviews, we conducted a literature search between August 2022 and April 2023, which identified studies with a substantial number of patients with POCD after major surgeries, including coronary artery bypass grafting, gastrointestinal procedures, cholecystectomy, and carotid endarterectomy. Our findings also demonstrated that a significant percentage of these had obesity, which was statistically significant as a risk factor for cognitive decline. Pathological processes, such as changes in vascular endothelium integrity, systemic inflammation induced by obesity, and apolipoprotein E-epsilon-4 expression, have been identified to contribute to POCD after surgery. Despite the promising results, there remains a gap in the literature. Thus, it is crucial to investigate the relationship between obesity and POCD further, uncover more potential underlying pathophysiological processes, and identify therapeutic targets. These measures would enable healthcare practitioners to prevent or reduce cognitive dysfunction associated with obesity in surgical patients.