Premium
Recommendations for a new perioperative cognitive impairment nomenclature
Author(s) -
Evered Lisbeth,
Silbert Brendan,
Scott David A.,
Eckenhoff Roderic G.
Publication year - 2019
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2019.05.005
Subject(s) - library science , publishing , history , media studies , sociology , political science , law , computer science
The nomenclature associated with postoperative cognitive impairment of all varieties, until very recently, has been limited to postoperative delirium and postoperative cognitive dysfunction (POCD) [1]. This nomenclature, and related studies of POCD in particular, has been associated with several limitations, including inconsistent definition, variable timing and magnitude, no consideration for symptoms, and minimal recognition outside of the specialty of anesthesiology. These limitations have resulted in large variances in POCD incidences and have made it difficult or impossible to conduct systematic reviews or meta-analyses of the many attempted interventions or to understand any clinical implications of this disorder. Furthermore, our geriatric medicine colleagues, who generally see these patients after discharge, do not recognize the term POCD and do not know what to label the cognitive syndrome that they often see. In fact, the term POCD is largely a research diagnosis, not even requiring a cognitive complaint from the individual. On the other hand, many surgical patients not participating in POCD studies do in fact have cognitive symptoms postoperatively but simply remain undiagnosed, and often very concerned, as they are only rarely informed of this complication. In recognition of these limitations, an interdisciplinary, international group deliberated over the course of three years to generate a new nomenclature for perioperative cognitive disorders, which was broadly published in six journals simultaneously in late 2018 [2]. The purpose of this letter is to familiarize the A&D readership with the basic elements of this terminology. To facilitate broad recognition in the medical community, the new terminology was aligned with that of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), and adopted the root term, “neurocognitive disorder (NCD).” Thus, the recommended umbrella term is now perioperative neurocognitive disorder, incorporating preoperative cognitive impairment and postoperative delirium and replacing the research term POCD with the clinical term NCD. After surgery, the