Biomarkers and postoperative cognitive function: could it be that easy?

TY - JOUR

T1 - Biomarkers and postoperative cognitive function: could it be that easy?

AU - Schaefer, Simon T

AU - Koenigsperger, Stephan

AU - Olotu, Cynthia

AU - Saller, Thomas

PY - 2019/2

Y1 - 2019/2

N2 - PURPOSE OF REVIEW: Neurocognitive dysfunction after surgery is highly relevant in the elderly. The multifactorial manner of this syndrome has made it hard to define an ideal biomarker to predict individual risk and assess diagnosis and severity of delirium [postoperative delirium (POD)] and subsequent postoperative cognitive decline (POCD). This review summarizes recent literature on blood biomarkers for POD/POCD.RECENT FINDINGS: Markers for delirium have been searched for in the cerebrospinal fluid to examine the pathologic cascade. However, cerebrospinal fluid cannot be easily obtained in the perioperative setting. Thus, attention shifts toward prediction markers from patients' blood to determine the individual risk. In this regard, three major groups of peripheral blood markers could be distinguished: first, global, but unspecific markers associated with POD/POCD; second, specific and established markers related to neurocognitive function; and third, upcoming or newly described markers with less evidence. Solely neuron-specific enolase is an adequate biomarker based on recent literature.SUMMARY: Single markers for postoperative cognitive impairment cannot predict POD/POCD in geriatric patients. However, a wisely arranged battery of promising biomarkers might achieve a satisfying sensitivity and specificity for the preoperative assessment of subsequent cognitive decline. Adequately powered studies to prove this hypothesis are required.

AB - PURPOSE OF REVIEW: Neurocognitive dysfunction after surgery is highly relevant in the elderly. The multifactorial manner of this syndrome has made it hard to define an ideal biomarker to predict individual risk and assess diagnosis and severity of delirium [postoperative delirium (POD)] and subsequent postoperative cognitive decline (POCD). This review summarizes recent literature on blood biomarkers for POD/POCD.RECENT FINDINGS: Markers for delirium have been searched for in the cerebrospinal fluid to examine the pathologic cascade. However, cerebrospinal fluid cannot be easily obtained in the perioperative setting. Thus, attention shifts toward prediction markers from patients' blood to determine the individual risk. In this regard, three major groups of peripheral blood markers could be distinguished: first, global, but unspecific markers associated with POD/POCD; second, specific and established markers related to neurocognitive function; and third, upcoming or newly described markers with less evidence. Solely neuron-specific enolase is an adequate biomarker based on recent literature.SUMMARY: Single markers for postoperative cognitive impairment cannot predict POD/POCD in geriatric patients. However, a wisely arranged battery of promising biomarkers might achieve a satisfying sensitivity and specificity for the preoperative assessment of subsequent cognitive decline. Adequately powered studies to prove this hypothesis are required.

KW - Journal Article

KW - Severity of Illness Index

KW - Anesthesia/adverse effects

KW - Predictive Value of Tests

KW - Prognosis

KW - Age Factors

KW - Biomarkers/analysis

KW - Humans

KW - Postoperative Period

KW - Cognitive Dysfunction/diagnosis

KW - Feasibility Studies

KW - Aging/physiology

KW - Emergence Delirium/diagnosis

KW - Surgical Procedures, Operative/adverse effects

KW - Cognition/drug effects

KW - Sensitivity and Specificity

KW - Aged

U2 - 10.1097/ACO.0000000000000676

DO - 10.1097/ACO.0000000000000676

M3 - SCORING: Review article

C2 - 30507679

VL - 32

SP - 92

EP - 100

JO - CURR OPIN ANESTHESIO

JF - CURR OPIN ANESTHESIO

SN - 0952-7907

IS - 1

ER -