The Relationship between Postoperative Cognitive Dysfunction and
Cerebral Small Vessel Disease: A Comprehensive Review
Abstract
Postoperative cognitive dysfunction (POCD) is a common complication in
elderly patients, and cerebral small vessel disease (CSVD) has been
suggested as a potential risk factor. This review examines the
relationship between POCD and CSVD from epidemiological,
pathophysiological, and clinical perspectives. Epidemiological studies
have shown that POCD and CSVD are associated in terms of common risk
factors, including advanced age, vascular comorbidities, impaired
baseline cognitive function, and certain population characteristics.
Animal studies have revealed that CSVD and POCD share similar
neuropathological changes, including abnormal cerebral hypoperfusion,
inflammatory responses, and blood-brain barrier disruption. Neuroimaging
studies have further demonstrated that preoperative CSVD burden and
postoperative CSVD progression are associated with the development of
POCD. The association between CSVD and POCD has important implications
for the perioperative management of elderly patients, including
preoperative assessment, choice of anesthesia and surgical methods,
intraoperative management, postoperative care, and long-term follow-up.
A better understanding of the relationship between CSVD and POCD will
guide evidence-based strategies to prevent and manage this debilitating
complication in the aging population.