Dysfonction cérébrale postopératoire du sujet âgé : dépistage et prévention

Postoperative cerebral dysfunction includes delirium, usually occurring early and reversible, and postoperative cognitive disorders, usually occurring later and prolonged. This is a frequent complication in patients older than 75-year-old. The two neurological pictures are often inter-related. The pathophysiology of both entities is similar and related to postoperative neuro-inflammation; therefore, onset may occur independently of any surgical complication. Postoperative cerebral dysfunction is a serious organic complication. Reduction of inflammation represents the most logical preventive measure but currently, there are no studies that show this to be effective. Prevention therefore means combining several minor measures, elements that fit well into programs of enhanced postoperative recovery after surgery. Diminished preoperative cognitive status being a major risk factor, preoperative rehabilitation combining nutritional, physical and cognitive support can be helpful.