PDF(Pubmed)
Abstract：
UNASSIGNED: To review how anecdote and narrative medicine, primary cohort studies, epidemiological studies, and the dementia literature can be bridged to understand long-term postoperative cognitive decline.
UNASSIGNED: Primary cohort studies have measured recoverable declines in memory and executive function after major surgery, but less-appreciated sources also offer critical insights. Anecdote reveals that functionally-impactful cognitive decline may persist after physical recovery in some patients despite modern medications and monitoring, and that physicians are unprepared to address patients\' cognitive concerns. However, epidemiological studies reproducibly demonstrate that elective surgery has no, or a negligible, average impact on cognition in older patients. Cognitively provocative factors - like medical hospital admissions or health factors like diabetes and smoking - are common in late life, and surgery likely contributes minimally to long-term cognitive change for most patients.
UNASSIGNED: Patients should be reassured that, while anecdotes of durable cognitive change after surgery are easily accessible, most patients experience cognitive recovery after major surgery. However, those who do not recover deserve characterization of their symptoms and investigation of modifiable causes to facilitate cognitive recovery.
UNASSIGNED: Primary cohort studies have measured recoverable declines in memory and executive function after major surgery, but less-appreciated sources also offer critical insights. Anecdote reveals that functionally-impactful cognitive decline may persist after physical recovery in some patients despite modern medications and monitoring, and that physicians are unprepared to address patients\' cognitive concerns. However, epidemiological studies reproducibly demonstrate that elective surgery has no, or a negligible, average impact on cognition in older patients. Cognitively provocative factors - like medical hospital admissions or health factors like diabetes and smoking - are common in late life, and surgery likely contributes minimally to long-term cognitive change for most patients.
UNASSIGNED: Patients should be reassured that, while anecdotes of durable cognitive change after surgery are easily accessible, most patients experience cognitive recovery after major surgery. However, those who do not recover deserve characterization of their symptoms and investigation of modifiable causes to facilitate cognitive recovery.
摘要：
■回顾轶事和叙事医学，主要队列研究，流行病学研究,和痴呆症文献可以桥接，以了解长期的术后认知能力下降。
■主要队列研究测量了大手术后记忆和执行功能的可恢复下降，但较少欣赏的来源也提供了重要的见解。轶事表明，尽管有现代药物和监测，但一些患者的身体恢复后，功能影响的认知能力下降可能会持续存在。医生还没有准备好解决患者的认知问题。然而,流行病学研究可重复地表明，选择性手术没有，或者一个微不足道的，对老年患者认知的平均影响。认知上的挑衅性因素——如住院医疗或健康因素，如糖尿病和吸烟——在晚年很常见，对于大多数患者来说，手术可能对长期认知改变的贡献最小。
■患者应该放心，虽然手术后持久认知变化的轶事很容易获得，大多数患者在大手术后认知恢复。然而,那些没有康复的人应该对他们的症状进行表征，并调查可改变的原因，以促进认知恢复。
■主要队列研究测量了大手术后记忆和执行功能的可恢复下降，但较少欣赏的来源也提供了重要的见解。轶事表明，尽管有现代药物和监测，但一些患者的身体恢复后，功能影响的认知能力下降可能会持续存在。医生还没有准备好解决患者的认知问题。然而,流行病学研究可重复地表明，选择性手术没有，或者一个微不足道的，对老年患者认知的平均影响。认知上的挑衅性因素——如住院医疗或健康因素，如糖尿病和吸烟——在晚年很常见，对于大多数患者来说，手术可能对长期认知改变的贡献最小。
■患者应该放心，虽然手术后持久认知变化的轶事很容易获得，大多数患者在大手术后认知恢复。然而,那些没有康复的人应该对他们的症状进行表征，并调查可改变的原因，以促进认知恢复。
