Abstract：
Elderly patients who undergo major surgery (not-neurosurgical) under general anaesthesia frequently complain about cognitive difficulties, especially during the first weeks after surgical \"trauma\". Although recovery usually occurs within a month, about one out of four patients develops full-blown postoperative Neurocognitive disorders (NCD) which compromise quality of life or daily autonomy. Mild/Major NCD affect approximately 10% of patients from three months to one year after major surgery. Neuroinflammation has emerged to have a critical role in the postoperative NCDs pathogenesis, through microglial activation and the release of pro-inflammatory cytokines which increase blood-brain-barrier permeability, enhance movement of leukocytes into the central nervous system (CNS) and favour the neuronal damage. Moreover, pre-existing Mild Cognitive Impairment, alcohol or drugs consumption, depression and other factors, together with several intraoperative and post-operative sequelae, can exacerbate the severity and duration of NCDs. In this context it is crucial rely on current progresses in serum and CSF biomarker analysis to frame neuroinflammation levels, along with establishing standard protocol for neuropsychological assessment (with specific set of tools) and to apply cognitive training or neuromodulation techniques to reduce the incidence of postoperative NCDs when required. It is recommended to identify those patients who would need such preventive intervention early, by including them in pre-operative and post-operative comprehensive evaluation and prevent the development of a full-blown dementia after surgery. This contribution reports all the recent progresses in the NCDs diagnostic classification, pathogenesis discoveries and possible treatments, with the aim to systematize current evidences and provide guidelines for multidisciplinary care.
摘要：
在全身麻醉下接受大手术（非神经外科手术）的老年患者经常抱怨认知困难，尤其是在手术“创伤”后的第一周。虽然恢复通常发生在一个月内，大约四分之一的患者发展为全面的术后神经认知障碍（NCD），这损害了生活质量或日常自主性。在大手术后三个月至一年内，轻度/重度NCD影响约10％的患者。神经炎症已在术后非传染性疾病发病机制中发挥关键作用，通过小胶质细胞活化和促炎细胞因子的释放，增加血脑屏障的通透性，增强白细胞进入中枢神经系统（CNS）的运动，有利于神经元损伤。此外，预先存在的轻度认知障碍，酒精或药物消费，抑郁和其他因素，连同一些术中和术后后遗症，会加剧非传染性疾病的严重程度和持续时间。在这种情况下，依赖于血清和CSF生物标志物分析的当前进展来构建神经炎症水平是至关重要的，以及建立神经心理学评估的标准协议（使用特定的工具集），并在需要时应用认知训练或神经调节技术来降低术后非传染性疾病的发生率。建议尽早确定需要这种预防性干预的患者，通过将它们纳入术前和术后综合评估，并防止术后全面痴呆的发展。本文报告了非传染性疾病诊断分类的所有最新进展，发病机制的发现和可能的治疗，目的是将现有证据系统化，并为多学科护理提供指导。
