Postoperative cognitive dysfunction (POCD) is common in elderly patients and significantly impairs their quality of life due to loss of memory and concentration. The decrease in mental performance and potential progression to overt dementia may have enormous socio-economic consequences. The aims of this project are to clarify these issues in 11 tasks involving a wide range of scientists from the fields of cognitive function, anaesthesia, pharmacology, cell biology, statistics, psychology, imaging and technical engineering.
Postoperative cognitive dysfunction (POCD) is common in elderly patients and significantly impairs their quality of life due to loss of memory and concentration. The decrease in mental performance and potential progression to overt dementia may have enormous socio-economic consequences. The former contradictory and inconclusive studies within this field prompted a multicentre study in 1800 patients and controls, ISPOCD 1, that was made possible by support from the BIOMED1 program. ISPOCD 1 showed that POCD occurs in 24% of elderly patients one-week postopera tively and in 10% after 3 months. Further derivatives were a European psychometric test battery, rigorous diagnostic criteria, and several flexible software programs for data acquisition, processing, and analysis. We do not know whether the condition represents permanent brain damage and the consequences, aetiology, and patophysiology are unknown. The aims of the proposed study (ISPOCD 2) are to clarify these issues in 11tasks involving a wide range of scientists from the fields of cognitive function, anaesthesia, pharmacology, cell biology, statistics, psychology, imaging and technical engineering. This concerted action comprises both tasks to be performed by all participating centres and tasks which will be undertaken by one or more collaborating centres.
All tasks will be co-ordinated to ensure standardised collection and processing of psychometric, clinical and laboratory data as well as centralised analysis and interpretation to allow valid conclusions to be drawn. Continuous international collaboration is essential in these studies due to the complexity and need for large sample sizes in the prospective clinical studies.
The tasks include: Long-term follow up 1-2 years after surgery and evaluation of dependency, The role of out-patient surgery, The influence of regional anaesthesia and specific anaesthetics (benzodiazepines), POCD in younger patients, Genetic predisposition, Cholinergic mechanisms evaluated by PET scan and in animal studies, The role of neuron damage evaluated by MR scan, SPECT scan and biochemical markers, The possible prophylactic effect of ondansetron.
The adoption of brain imaging and laboratory techniques requires the addition of appropriate expertise to the research group which conducted ISPOCD 1. All necessary technology is in regular use in the participating centres. All studies will be conducted according to regional and international requirements for informed consent and other details of human and animal experimentation. POCD is expected to affect approximately 1 million EU citizens annually and we are convinced that this extremely important but complex clinical problem demands a co-ordinated international effort through the execution of the ambitious but realistic program of studies that comprise this ISPOCD 2 proposal.05 05