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Effects of Post-Operative Cognitive Dysfunction after Spinal Anesthesia between Geriatric and Middle-Aged Patients


Article Information

Title: Effects of Post-Operative Cognitive Dysfunction after Spinal Anesthesia between Geriatric and Middle-Aged Patients

Authors: Saad Hameed, Abdul Hameed Bhatti, Shizan Hamid Feroz, Nabeel Tahir Butt, Kenan Anwar khan, Najaf Imtiaz Cheema

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History
Category From To
Y 2024-10-01 2025-12-31
Y 2023-07-01 2024-09-30
Y 2021-07-01 2022-06-30
Y 2020-07-01 2021-06-30
Y 1900-01-01 2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2024

Volume: 74

Issue: 4

Language: English

Keywords: Cognitive dysfunctionGeriatricMiddle agedSpinal anesthesia.

Categories

Abstract

Objective: To compare the effects of Post-Operative Cognitive Dysfunction after spinal anesthesia between geriatric and middle-aged patients presenting for elective surgery.
Study Design: Quasi-experimental study.
Place and Duration of Study: Anesthesia Department of Combined Military Hospital, Peshawar Pakistan, from Jan to Jun 2022.
Methodology: A total of 90 patients were included in the study divided into the geriatric group (Group-A, n=45) and the middle age group (Group-B, n=45) according to ages defined. Primary variables measured were Mini-Mental State Examination pre-operatively and 12 and 24 hours after surgery for cognitive impairment.
Results: Mean age of patients was 64.56±3.85 years in the geriatric versus 38.11±3.62 years in the middle age group. The mean total MMSE score out of 30 was 24.36±1.5 in the geriatric versus 25.58±1.3 in the middle age group at the 12-hour interval (p<0.001). The score improved at the 24-hour interval but was still hampered in the geriatric Group more than the middle age group, 26.76±1.00 versus 27.36±0.74 (p<0.001).
Conclusion: We conclude that neuraxial anesthesia is associated with deterioration in logical and analytical memory both in the middle age and geriatric age group with return to full neurological function early in the middle age group


Research Objective

To compare the effects of Post-Operative Cognitive Dysfunction (POCD) after spinal anesthesia between geriatric and middle-aged patients undergoing elective surgery.


Methodology

Quasi-experimental study conducted at the Anesthesia Department of Combined Military Hospital, Peshawar Pakistan, from January to June 2022. Ninety patients were divided into a geriatric group (n=45, ages 50-65) and a middle-aged group (n=45, ages 35-49). Mini-Mental State Examination (MMSE) was administered pre-operatively and at 12 and 24 hours post-operatively.

Methodology Flowchart
                        graph TD
    A[Patient Recruitment] --> B[Informed Consent];
    B --> C[Inclusion/Exclusion Criteria];
    C -- Yes --> D[Baseline MMSE];
    D --> E[Spinal Anesthesia];
    E --> F[Surgery];
    F --> G[Post-operative Care];
    G --> H[MMSE at 12 hours];
    H --> I[MMSE at 24 hours];
    I --> J[Data Analysis];
    J --> K[Conclusion];
    C -- No --> L[Excluded from Study];                    

Discussion

Cognitive impairment was more pronounced in the geriatric group, aligning with previous studies. The study suggests that spinal anesthesia-induced cognitive decline, particularly in logical and analytical memory, is more significant in older patients.


Key Findings

The geriatric group had significantly lower mean total MMSE scores at the 12-hour (24.36) and 24-hour (26.76) intervals compared to the middle-aged group (25.58 and 27.36, respectively) (p<0.001). Specific MMSE parameters like attention, calculation, and recall were more affected in the geriatric group.


Conclusion

Neuraxial anesthesia is associated with a decline in logical and analytical memory in both middle-aged and geriatric patients, with a faster return to full neurological function in the middle-aged group.


Fact Check

1. Study duration: January to June 2022 - Confirmed in the Methodology section.
2. Sample size: 90 patients - Confirmed in the Methodology section.
3. MMSE score at 12 hours for geriatric group: 24.36 - Confirmed in the Results section.


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