METHODS: A prospective, 5-year longitudinal, cohort study was performed recruiting patients (aged ≥ 60 y) undergoing elective orthopaedic surgery and a contemporaneous non-surgical control group. Neurocognitive disorder was evaluated and classified at baseline and 5-year review incorporating: self- and informant-reported cognition; functional participation; and performance on neuropsychological tests.
RESULTS: Recruitment at 5-year follow-up included 195 patients and 21 control participants. In the patient cohort the prevalence of neurocognitive disorder was 38.1% (n = 75), with 61 (30.1%) meeting the criteria for mild neurocognitive disorder and 14 (7.1%) for major neurocognitive disorder. At 5-year follow-up, 121 (61.4%) patients were classified with a neurocognitive disorder, with 88 (44.7%) characterised with mild neurocognitive disorder and 33 (16.8%) with major neurocognitive disorder. Age (odds ratio (95%CI) 1.07 (1.02-1.13); p = 0.01) and baseline cognitive impairment (odds ratio (95%CI) 2.1 (1.06-4.15); p = 0.03) were significant predictors of neurocognitive disorder 5 years after surgery.
CONCLUSIONS: More than half of older adult patients had some form of neurocognitive disorder 5 years after elective orthopaedic surgery. Surgery and anaesthesia may be associated with the trajectory of cognitive decline in at-risk older adults, including those with pre-operative cognitive impairment. Cognitive screening should be factored into pre-operative assessments of older adults to inform subsequent care.
方法:前瞻性,5年纵向,队列研究招募接受择期骨科手术的患者(年龄≥60岁)和同期非手术对照组.在基线和5年审查时对神经认知障碍进行了评估和分类,包括:自我和信息报告的认知;功能参与;以及神经心理学测试的表现。
结果:在5年随访时招募了195名患者和21名对照参与者。在患者队列中,神经认知障碍的患病率为38.1%(n=75),61(30.1%)符合轻度神经认知障碍的标准,14(7.1%)符合主要神经认知障碍的标准。在5年的随访中,121例(61.4%)患者被归类为神经认知障碍,其中88例(44.7%)患有轻度神经认知障碍,33例(16.8%)患有重度神经认知障碍。年龄(比值比(95CI)1.07(1.02-1.13);p=0.01)和基线认知障碍(比值比(95CI)2.1(1.06-4.15);p=0.03)是术后5年神经认知障碍的显著预测因子。
结论:超过一半的老年患者在择期骨科手术5年后出现某种形式的神经认知障碍。手术和麻醉可能与高危老年人认知功能下降的轨迹有关。包括术前认知障碍患者.认知筛查应纳入老年人的术前评估,以告知后续护理。