الفهرس 
Brain AnatomyOnly 14 pages are availabe for public view
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Abstract
he precise mechanisms for POCD are still far from being
clearly elucidated. Due to the pharmacological
properties, the application of anesthetics induces acute effects
which on one hand blocks learning and memory and on the
other hand exerts neuroprotective activities. These in vitro
characteristics would exhibit a preferable profile of
anesthetics: the patient is protected from undesirable
memories and possible neurodegeneration which might be
induced during surgery. Unfortunately, there is clear evidence
that a considerable proportion of people, dependent on risk
factors, suffer from cognitive dysfunction described either as
anticholinergic syndrome, delirium or POCD after surgery. At
this point it should be stressed that the choice of anesthetic
most probably does not influence the incidence of POCD and
thus rather speaks in favor of a minor role for anesthesia in
contributing to the development of cognitive impairment after
surgery.
The interpretation of available data on POCD is
accompanied by numerous methodological deficits.
Overcoming those problems would imply the planning and
performance of powerful clinical studies with comparable
surgery, standardized neuopsychological tests and defined
diagnostic criteria used to classify individuals as having
POCD. Concomitantly, the availability of such meaningful data would be useful for the development and application of
non-pharmacological and pharmacological neuroprotective
strategies.
Improvement in surgical technique, anesthesia and
intensive care has made it possible for elderly patients to
undergo major surgical procedures that successfully prolong
life. However, the occurrence of postoperative cognitive
decline may affect their quality of life. POCD is multifactorial
in origin, with increasing age as the leading risk factor, yet the
mechanism is not fully understood. There is no convincing
evidence to suggest general anesthesia causes occurrence of
POCD, as the incidence of POCD is equivalent between
patients receiving general and regional anesthesia.