Peri-operative neurocognitive disorders are the most common complication experienced by older individuals undergoing anaesthesia and surgery. Peri-operative neurocognitive disorders, particularly postoperative delirium, result in long-term poor outcomes including: death; dementia; loss of independence; and poor cognitive and functional outcomes. Recent changes to the nomenclature of these disorders aims to align peri-operative neurocognitive disorders with cognitive disorders in the community, with consistent definitions and clinical diagnosis. Possible mechanisms include: undiagnosed neurodegenerative disease; inflammation and resulting neuroinflammation; neuronal damage; and comorbid systemic disease. Pre-operative frailty represents a significant risk for poor postoperative outcomes; it is associated with an increase in the incidence of cognitive decline at 3 and 12 months postoperatively. In addition to cognitive decline, frailty is associated with poor functional outcomes following elective non-cardiac surgery. It was recently shown that 29% of frail patients died or experienced institutionalisation or new disability within 90 days of major elective surgery. Identification of vulnerable patients before undergoing surgery and anaesthesia is the key to preventing peri-operative neurocognitive disorders. Current approaches include: pre-operative delirium and cognitive screening; blood biomarker analysis; intra-operative management that may reduce the incidence of postoperative delirium such as lighter anaesthesia using processed electroencephalography devices; and introduction of guidelines which may reduce or prevent delirium and postoperative neurocognitive disorders. This review will address these issues and advocate for an approach to care for older peri-operative patients which starts in the community and continues throughout the pre-operative, intra-operative, postoperative and post-discharge phases of care management, involving multidisciplinary medical teams, as well as family and caregivers wherever possible.

中文翻译：

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急性围手术期神经认知障碍：叙述性回顾。

围手术期神经认知障碍是接受麻醉和手术的老年人最常见的并发症。围手术期神经认知障碍，尤其是术后谵妄，会导致长期不良结局，包括：死亡；失智; 丧失独立性；以及较差的认知和功能结果。最近对这些疾病命名法的变化旨在使围手术期神经认知障碍与社区中的认知障碍保持一致，并具有一致的定义和临床诊断。可能的机制包括：未确诊的神经退行性疾病；炎症和由此产生的神经炎症；神经元损伤；并合并全身性疾病。术前虚弱是术后结果不佳的重大风险；它与术后 3 个月和 12 个月认知能力下降的发生率增加有关。除了认知能力下降外，虚弱与择期非心脏手术后的不良功能结果有关。最近的研究表明，29% 的体弱患者在重大择期手术后 90 天内死亡或经历住院治疗或新的残疾。在接受手术和麻醉前识别易感患者是预防围手术期神经认知障碍的关键。目前的方法包括：术前谵妄和认知筛查；血液生物标志物分析；术中管理可以减少术后谵妄的发生率，例如使用加工过的脑电图设备进行较轻的麻醉；并引入可减少或预防谵妄和术后神经认知障碍的指南。本次审查将解决这些问题，并倡导一种方法来护理老年围手术期患者，该方法从社区开始，并贯穿护理管理的术前、术中、术后和出院后阶段，涉及多学科医疗团队，以及尽可能与家人和看护人联系。