Dysfonctions cognitives postopératoires

Cognitive dysfunction is a dreaded complication of the perioperative period in the elderly surgical population. It refers to any cognitive impairment occurring after the second postoperative day, which then must be considered pathological. There are two chronologically distinct entities among these cognitive disorders: delirium from day 3 to day 7, and postoperative cognitive dysfunction after the first week. More and more experimental and epidemiological evidences suggest that perioperative inflammation is a key element in the genesis of postoperative cognitive disorders. Very few studies have evaluated the impact of a prevention strategy on the occurrence of postoperative cognitive disorders, and there is no treatment validated to date. However, a thorough pre-anesthetic assessment is essential in order to optimize the management of the perioperative period, and precipitating organic factors should always be sought and eliminated.