Cognitive Reserve and the Risk of Postoperative Cognitive Dysfunction.

IF 7.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Deutsches Arzteblatt international Pub Date : 2017-02-17 DOI:10.3238/arztebl.2017.0110

Insa Feinkohl, Georg Winterer, Claudia D Spies, Tobias Pischon

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Abstract

Background: Post-operative cognitive dysfunction (POCD) occurs in 10 to 54% of older patients during the first few weeks after surgery, but little is known about risk factors predisposing to POCD.

Methods: Systematic literature review and meta-analysis of cognitive reserve indicators and POCD risk.

Results: Fifteen studies on 5104 patients were included. Follow-up periods spanned 1 day to 6 months. Educational level was the most commonly assessed cognitive reserve indicator, and a longer time spent in education was associated with a reduced risk of POCD (relative risk [RR] per year increment 0.90; 95% confidence interval: [0.87; 0.94]), i.e. each year increase in education was associated with a 10% reduced risk. Similar findings were made for some analyses on education as a categorical predictor (high school versus further/higher education, RR 1.71, [1.30; 2.25]; lower than high school versus further/higher education, RR 1.69, [1.17; 2.44]) though risk was equivalent for patients with high school education and those with lower than high school education (RR 1.02; [0.78; 1.32]).

Conclusion: Patients with a relatively higher level of education are at reduced risk of POCD. Risk stratification of surgical patients according to educational level may prove useful.

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认知储备与术后认知功能障碍的风险。

背景:10 - 54%的老年患者在术后最初几周内发生术后认知功能障碍(POCD)，但对导致POCD的危险因素知之甚少。方法:系统文献综述和认知储备指标与POCD风险的meta分析。结果:纳入15项研究，5104例患者。随访时间从1天到6个月不等。受教育程度是最常见的认知储备评估指标，受教育时间越长，POCD风险越低(相对风险[RR]每年增加0.90;95%置信区间:[0.87;0.94])，即教育水平每年提高与风险降低10%相关。类似的结果也出现在教育作为分类预测因子的一些分析中(高中与继续/高等教育，RR 1.71， [1.30;2.25);低于高中与继续/高等教育，RR 1.69， [1.17];2.44])，但高中教育程度与低于高中教育程度的患者的风险相当(RR 1.02;(0.78;1.32])。结论:受教育程度较高的患者发生POCD的风险较低。根据受教育程度对手术患者进行风险分层可能是有用的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Deutsches Arzteblatt international 医学-医学：内科

CiteScore

4.10

自引率

5.20%

发文量

306

审稿时长

4-8 weeks

期刊介绍： Deutsches Ärzteblatt International is a bilingual (German and English) weekly online journal that focuses on clinical medicine and public health. It serves as the official publication for both the German Medical Association and the National Association of Statutory Health Insurance Physicians. The journal is dedicated to publishing independent, peer-reviewed articles that cover a wide range of clinical medicine disciplines. It also features editorials and a dedicated section for scientific discussion, known as correspondence. The journal aims to provide valuable medical information to its international readership and offers insights into the German medical landscape. Since its launch in January 2008, Deutsches Ärzteblatt International has been recognized and included in several prestigious databases, which helps to ensure its content is accessible and credible to the global medical community. These databases include: Carelit CINAHL (Cumulative Index to Nursing and Allied Health Literature) Compendex DOAJ (Directory of Open Access Journals) EMBASE (Excerpta Medica database) EMNursing GEOBASE (Geoscience & Environmental Data) HINARI (Health InterNetwork Access to Research Initiative) Index Copernicus Medline (MEDLARS Online) Medpilot PsycINFO (Psychological Information Database) Science Citation Index Expanded Scopus By being indexed in these databases, Deutsches Ärzteblatt International's articles are made available to researchers, clinicians, and healthcare professionals worldwide, contributing to the global exchange of medical knowledge and research.