Özet:

Introduction: With the ageing population, elderly patients are overrepresented among surgical patients, and experience an increased variety of postoperative complications. Of these complications, perioperative neurocognitive disorders significantly jeopardize patients" postoperative outcomes. Risk factors for perioperative neurocognitive disorders include age, depth of anesthesia, preoperative cognitive function, and surgical procedure type. However, the underlying pathophysiological mechanisms are still not well understood and have been the focus of multiple previous studies. This narrative review aimed to define the possible pathophysiological pathways of perioperative neurocognitive disorders from different cellular perspectives. Method: A literature search was conducted using the following keywords: perioperative neurocognitive disorders, delirium AND synaptic dysfunction, neuroinflammation, and pathophysiology, focusing on studies published within the last 10 years. All studies written in English, reporting perioperative neurocognitive disorders and its pathophysiological mechanisms in adults undergoing elective surgery were included. Results: A total of 516 studies were assessed and 182 studies were selected. Among the 182 studies, 60 most relevant to the research question regarding the cellular mechanisms of perioperative neurocognitive disorders were included. Conclusion: Perioperative neurocognitive disorders are important perioperative complications, and early recognition, prevention, and treatment of high-risk patients are crucial. Neurocognitive tests are commonly used to identify and assess perioperative neurocognitive disorders. However, new biomarkers are required to better understand the pathophysiology. Furthermore, defining the underlying molecular mechanisms and related pathways, which could possibly serve as predictive tools and possible targets for treatment, is important to better delineate the risks especially in the elderly population.

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