Pathogenesis and treatment of post-operative cognitive dysfunction

Cognitive disorders common in the post-operative period, are the post-operative delirium (POD) and the post-operative cognitive dysfunction (POCD). The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not mention POCD as a separate disease entity, and thus little is known about the pathogenesis of this disorder. The aim of this study was to review, detect and highlight the most important data cited, regarding pathogenesis mechanisms and treatment of the post-operative cognitive dysfunction (POCD). The study was carried out from March 2015 to June 2015. Literature review was achieved by searching a number of bibliographic databases including PubMed, Google Scholar and SCOPUS, surveying published articles from 1955 to 2014. As far as the selection criteria, the material consists of scientific articles published mainly over the last fifteen years, while material published before 2000 was selected because it was considered to be important. This review showed that deficits are observed in one or more discrete areas of the patient’s mental state, such as attention, concentration, memory, psychomotor speed and more. This condition is usually developed over a period of more than a week or month after surgery and is more common in elderly patients. Mechanisms that have been proposed to explain this phenomenon are hyperventilation, hypotension, cerebral microemboli and inflammatory mechanisms. Its differential diagnosis will be made mainly from delirium. POCD treatment will first include the exclusion of any other serious diseases that can cause organic psychosyndrome and then focus on the actual symptoms.