Relationship between perioperative inflammatory response and postoperative cognitive dysfunction in the elderly

After surgery and anesthesia, many elderly patients show a decline in cognitive function. This condition is called postoperative cognitive dysfunction (POCD). POCD, a distressing complication after surgery, is independently associated with poor short-term and long-term outcomes. Many pathophysiological mechanisms have been implicated in development of POCD, but the exact cascade leading to its development is unclear. Animal studies show that cytokines from inflammatory response are involved in with cognitive dysfunction. Simultaneously, emerging evidences indicate that inflammatory response represents a potential pathogenic factor in many central cognitive diseases. A similar story may be occurring during perioperative process in patients. Surgical trauma, anesthesia, and stress response induced perioperative nonspecific inflammatory response. We hypothesize that perioperative inflammatory response promotes the development of POCD in elderly surgical patients, and some measures against perioperative inflammatory response should be considered as a new pathway to prevention of POCD. (C) 2009 Elsevier Ltd. All rights reserved.