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Postoperative cognitive dysfunction and dementia: what we need to know and do
Needham MJ, Webb CE, Bryden DC.. British journal of anaesthesia, 2017-12-01
Topic: Risk, prevention and care in population studies
Approximately 12% of apparently previously cognitively well patients undergoing anaesthesia and noncardiac surgery will develop symptoms of cognitive dysfunction after their procedure. Recent articles in this Journal have highlighted the difficulties of confirming any clear links between anaesthesia and cognitive dysfunction, in part because of the lack of consistency regarding definition and diagnosis. Postoperative cognitive dysfunction (POCD) is usually self-limiting and rarely persists in the longer term, although plausible biological mechanisms for an impact on brain protein deposition do exist. Clinical research studies are frequently confounded by a lack of agreed definitions and consistency of testing. Preoperative assessment of neurocognitive function and risk factor identification is imperative in order to ascertain the true extent of POCD and any causative link to anaesthesia and surgery. At present a multidisciplinary care bundle approach to risk factor stratification and reduction is the most attractive management plan based on evidence of slight benefit from individual interventions. As yet no individual anaesthetic technique, drug or mode of monitoring has been proved to reduce the incidence of POCD. Providing patients with appropriate and accurate information can be difficult because of conflicting evidence. The Royal College of Anaesthetists' patient liaison group has produced a useful patient information leaflet that is designed to provide guidance in discussions of individual risks whilst considerable uncertainties remain.
Key findings
- Preoperative assessment of neurocognitive function and risk factor identification is imperative in order to ascertain the true extent of POCD and any causative link to anaesthesia and surgery.
- At present a multidisciplinary care bundle approach to risk factor stratification and reduction is the most attractive management plan based on evidence of slight benefit from individual interventions.
- As yet no individual anaesthetic technique, drug or mode of monitoring has been proved to reduce the incidence of POCD.
- Providing patients with appropriate and accurate information can be difficult because of conflicting evidence.
- The Royal College of Anaesthetists' patient liaison group has produced a useful patient information leaflet that is designed to provide guidance in discussions of individual risks whilst considerable uncertainties remain.
Why it matters
This review states that postoperative cognitive dysfunction is usually self-limiting and rarely persists long term, and that no individual anaesthetic technique, drug, or monitoring method has been proven to reduce its incidence. It recommends preoperative assessment and a multidisciplinary care bundle approach to identify and reduce risk factors.
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Study details
- Evidence strengthLow
How this study scored 44/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (British journal of anaesthesia) |
| Journal's citation record | 3 / 4 | British Journal of Anaesthesia: journal h-index 288 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2017 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 421 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 38.3 citations a year over 11 year(s) since 2017 |
| Impact for its field and year | 3 / 6 | Cited 7.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 3 / 4 | Cited 172 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Daniele C. Bryden: h-index 16 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | Sheffield Teaching Hospitals NHS Foundation Trust: institution h-index 323 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 29161395) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 44 / 100 | — |
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Read the original
- DOI: 10.1093/bja/aex354
- PubMed: 29161395
- Original source →
- Free full text: British Journal of Anaesthesia →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Needham, M. J., Webb, C. E., & Bryden, D. C. (2017). Postoperative cognitive dysfunction and dementia: what we need to know and do. British journal of anaesthesia. https://doi.org/10.1093/bja/aex354
Vancouver
Needham MJ, Webb CE, Bryden DC. Postoperative cognitive dysfunction and dementia: what we need to know and do. British journal of anaesthesia. 2017. doi:10.1093/bja/aex354. PMID: 29161395.
BibTeX
@article{needham2017-29161395,
author = {Needham, M. J. and Webb, C. E. and Bryden, D. C.},
title = {{Postoperative cognitive dysfunction and dementia: what we need to know and do}},
journal = {British journal of anaesthesia},
year = {2017},
doi = {10.1093/bja/aex354},
pmid = {29161395},
url = {https://doi.org/10.1093/bja/aex354}
}
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