NEUROCOGNITIVE SEQUELAE OF GENERAL ANESTHESIA IN ELDERLY PATIENTS: A LONGITUDINAL ANALYSIS OF POSTOPERATIVE COGNITIVE DYSFUNCTION (POCD) AND NEUROINFLAMMATION BIOMARKERS

Abstract

Postoperative cognitive dysfunction (POCD) is an increasingly recognized complication among elderly patients undergoing general anesthesia, with neuroinflammation emerging as a key mechanistic contributor. This longitudinal, mixed-methods study investigated the incidence, trajectory, and biological underpinnings of POCD in 300 patients aged ≥65 undergoing elective non-cardiac surgery. Cognitive assessments (MMSE, MoCA, Trail Making Tests A and B) were conducted preoperatively and at 7 days, 1 month, and 3 months postoperatively. A number of fifty subjects had cerebrospinal fluid (CSF) sampling to examine brain inflammation while blood levels of particular pro-inflammatory cytokines (IL-1β, IL-6, TNF-α) were evaluated during four time periods.  Three weeks after the procedure, the number of hospital patients with POCD had dropped; 31.6% had POCD at seven days but only 10.3% had it at the three-month mark.  Cognitive ability dropped a lot after surgery; however, partial recovery was made three months later.  In both of these fluids, IL-6 went up mainly 24 hours after the surgery and closely correlated with how severe the POCD was.  After applying logistic regression, age 75 or above, elevated IL-6 within 24 hours, dropping blood pressure during surgery, poor quality of sleep and delirium following surgery were the independent risk factors for POCD.  Such interviews revealed that main psychosocial effects in cancer patients can be emotional distress, less effective communication and weak coping strategies.  According to this study, we notice that POCD is complex, how neuroinflammation forms a key role and how certain cytokine biomarkers might offer early detection and risk evaluation.  The findings point out that older individuals need tailored pre-, intra- and post-operative care with cognitive checks, monitoring for inflammation and assistance from different healthcare professionals.  Concern for cognitive health must always be a main focus in planning surgeries since seniors are becoming a bigger segment of the population.