Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery—2018¹

Article type: Research Article

Authors: Evered, L.^{a; b; *} | Silbert, B.^{a; b} | Knopman, D.S.^c | Scott, D.A.^{a; b} | DeKosky, S.T.^d | Rasmussen, L.S.^e | Oh, E.S.^f | Crosby, G.^g | Berger, M.^h | Eckenhoff, R.G.ⁱ | The Nomenclature Consensus Working Group²

Affiliations: [a] St Vincent’s Hospital, Melbourne, Fitzroy, VIC, Australia | [b] University of Melbourne, Fitzroy, VIC, Australia | [c] Department of Neurology, Mayo Clinic, Rochester, MN, USA | [d] Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA | [e] Department of Anaesthesia, Center of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark | [f] Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA | [g] Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA | [h] Neurologic Outcomes Research Group, Anesthesiology Department, Duke University Medical Center, Durham, NC, USA | [i] Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Correspondence: [*] Correspondence to: L.Evered. E-mail: [email protected].

Note: [1] This article has been published simultaneously in British Journal of Anaesthesia; Anesthesiology; Anesthesia & Analgesia; Canadian Journal of Anesthesia; Acta Anaesthesiologica Scandinavica; and Journal of Alzheimer’s Disease and all publications should be cited.

Note: [2] The Nomenclature Consensus Working Group participants and affiliations are listed in Appendix B section.

Abstract: Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face-to-face meetings followed by online editing of draft versions. Two major classification guidelines [Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) and National Institute for Aging and the Alzheimer Association (NIA-AA)] are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that ‘perioperative neurocognitive disorders’ be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).

Keywords: Cognition disorders, delirium, neurocognitive disorders, postoperative complications

DOI: 10.3233/JAD-189004

Journal: Journal of Alzheimer's Disease, vol. 66, no. 1, pp. 1-10, 2018