BACKGROUND The impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery under general anesthesia and development of delayed neurocognitive recovery in a subset of patients. Existing literature continues to debate whether these short-term effects on cognition can be attributed to anesthetic agents themselves, or whether other variables are causative of the observed changes in cognition. Furthermore, there is conflicting data on the relationship between anesthesia exposure and the development of long-term neurocognitive disorders, or development of incident dementia in the patient population with normal preoperative cognitive function. Patients with pre-existing cognitive impairment present a unique set of anesthetic considerations, including potential medication interactions, challenges with cooperation during assessment and non-general anesthesia techniques, and the possibility that pre-existing cognitive impairment may impart a susceptibility to further cognitive dysfunction. MAIN BODY This review highlights landmark and recent studies in the field, and explores potential mechanisms involved in perioperative cognitive disorders (also known as postoperative cognitive dysfunction, POCD). Specifically, we will review clinical and preclinical evidence which implicates alterations to tau protein, inflammation, calcium dysregulation, and mitochondrial dysfunction. As our population ages and the prevalence of Alzheimer's disease and other forms of dementia continues to increase, we require a greater understanding of potential modifiable factors that impact perioperative cognitive impairment. CONCLUSIONS Future research should aim to further characterize the associated risk factors and determine whether certain anesthetic approaches or other interventions may lower the potential risk which may be conferred by anesthesia and/or surgery in susceptible individuals.

中文翻译：

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麻醉学和认知障碍：对当前临床文献的叙述性综述。

背景技术全身麻醉对认知障碍的影响是有争议的且复杂的。大量证据支持在全身麻醉下接受手术与部分患者的神经认知恢复延迟发展之间的关联。现有文献继续争论这些对认知的短期影响是否可以归因于麻醉剂本身，还是其他变量是否导致观察到的认知变化。此外，在术前认知功能正常的患者中，麻醉暴露与长期神经认知障碍的发展或事件性痴呆的发展之间存在相互矛盾的数据。既往存在认知障碍的患者呈现出一系列独特的麻醉注意事项，包括潜在的药物相互作用，评估过程中的合作挑战以及非全身麻醉技术，以及先前存在的认知障碍可能使进一步的认知功能障碍易感性的可能性。主体本综述重点介绍了该领域的标志性研究和最新研究，并探讨了围手术期认知障碍（也称为术后认知功能障碍，POCD）的潜在机制。具体来说，我们将审查涉及tau蛋白，炎症，钙调节异常和线粒体功能障碍的改变的临床和临床前证据。随着我们的人口老龄化以及阿尔茨海默氏病和其他形式的痴呆症的患病率持续上升，我们需要对影响围手术期认知障碍的潜在可调节因素有更深入的了解。结论未来的研究应旨在进一步表征相关的危险因素，并确定某些麻醉方法或其他干预措施是否可以降低易感性个体的麻醉和/或手术所带来的潜在风险。