| Objective:Post-Operative Cognitive Dysfunction(POCD,now known as Perioperative Neurocognitive Dysfunction,PND)which occurs in elderly patients has a high incidence.There are many factors affecting POCD.Existing evidence shows that living style has a certain impact on people’s cognitive function.However,its effect on POCD in elderly patients is not clear.Therefore,this study investigated the effect of living style on the incidence of POCD in elderly patients.Methods:162 patients(over 65 years old,ASA I~III)who underwent non-cardiac and non-neurosurgery were divided into five groups:residence group with spouse and their children(group A,n=37),group with spouse(group B,n=30),group with children(group C,n=37),solitary group(group D,n=37),nursing home residence group(group E,n=21),according to the different living style before operation.All patients were evaluated with MMSE score and MoCA score 1 day before operation,3days after operation and 5 days after operation.The changes of cognitive function before and after anesthesia were compared among the five groups,and the influence of living style on the incidence of POCD was analyzed.Results:1.There was no distinct difference in age,sex,years of education,operation time,anesthesia time and postoperative VAS score between the five groups(p> 0.05).2.The preoperative MMSE scores of group A,B,C,D,E were 26.00(25.00-27.00),25.00(23.00-26.00),24.00(23.00-26.00),24.00(21.00-26.00)and 23.00(21.00-23.00)which had a statistically significant difference(p<0.001).Among those groups,the lowest scores of groups were group D and group E,which were significantly lower than that of group A.Group B was significantly lower than that of group A(p=0.025).Group C was significantly lower than that of group A(p=0.001).Group D was significantly lower than that of group A(p<0.001).Group E was significantly lower than group A(p<0.001).Group E was significantly lower than group B(p =0.022).According to MMSE score,the incidence of preoperative cognitive dysfunction was 8.11%,16.67%,18.92%,32.43% and 38.10%,respectively.Group D and group E were the highest,significantly higher than that of group A.Group D was significantly higher than group A(p=0.009).Group E was significantly higher than group A(p=0.014).3.The preoperative MoCA scores of the five groups were 25.76±1.42,24.13±2.16,24.05±1.93,23.41±2.78,22.90±1.97,respectively(p<0.001),in which group D,and group E is the lowest,obviously lower than group A.B group was significantly lower than group A(p=0.002).C group was significantly lower than group A(p<0.001).Group D was significantly lower than group A(p<0.001).Group E was significantly lower than group A(p<0.001).Group E was significantly lower than group B(p =0.042).Group E was obviously lower than group C(p=0.048).The incidence of pre-operative cognitive impairment was 8.11%,20.00%,21.62%,29.73% and 38.10% in five groups.There was no distinct difference between these groups(p>0.05).4.The rates of preoperative cognitive impairment which were diagnosed by two scoring scales were compared.The incidence of pre-operative cognitive impairment was similar between the two scales(MMSE and MoCA).5.The decrease of MMSE score after operation was compared.The decrease of MMSE score in group A,B,C,D,E was 2.54±1.17,2.50±1.55,2.68±2.15,3.70±1.71,3.86±1.39,respectively,and there was a significant difference between groups(p=0.001).The decrease of MMSE in group D and group E was significantly higher than that in group A,group B and group C.The decreased value of group D was significantly greater than that of group A(p=0.03).The decrease in group E was significantly greater than that in group A(p=0.04).The decrease in group D was significantly higher than that in group B(p=0.04).The decrease of group E was significantly higher than that of group B(p=0.04).The value of decrease in group D was significantly higher than that in group C(p=0.008).The decrease in group E was significantly greater than that in group C(p=0.01).5 days after operation,the decrease of MMSE scores in group A,B,C,D,E were1.00(1.00-2.00)and 1.00(1.00-3.00),1.00(0.00-3.00),2.00(2.00-4.00),3.00(2.00-4.00),the difference is statistically significant(p<0.001).The decrease of MMSE in group D and group E was significantly higher than that in group A and group C.The decreased value of group D was significantly greater than that of group A(p=0.028).The decrease value in group E was significantly higher than that in group A(p=0.005).The decreased value of group D was significantly greater than that of group C(p=0.005).The decrease in group E was significantly higher than that in group C(p=0.001).6.The decrease of MoCA score after operation was compared.The decreased values of the MoCA scores were 2.73±0.99,3.37±1.25,3.65±1.25,4.00±1.39,4.05±1.28 respectively 3 days after operation,and the difference was statistically significant(p<0.001).In group B,group C,group D and group E,the MoCA decreased values were significantly greater than that of group A.The decrease in group B was significantly greater than that of group A(p=0.037).The value of decrease in group C was significantly higher than that in group A(p=0.002).The decrease in group D was significantly higher than that in group A(p<0.001).The decrease in group E was significantly higher than that in group A(p<0.001).The value of decrease in group D was significantly higher than that in group B(p=0.039).The decrease of MoCA score in group A,B,C,D,E was 1.41±0.96,2.13±1.22,2.43±1.56,2.81±1.65,3.38±1.86 respectively on the 5th day after operation,and the difference was statistically significant(p<0.001).In group B,C,D,E,the MoCA decreased values were significantly greater than that of group A.The decrease value in group B was significantly higher than that in group A(p=0.043).The decrease in group C was significantly greater than that of group A(p=0.003).The value of decrease in group D was significantly higher than that in group A(p<0.001).The decrease in group E was significantly greater than that in group A(p<0.001).The decrease value of group E was significantly higher than that of group B and group C.The decrease in group E was significantly higher than that in group B(p=0.003).The decrease in group E was significantly higher than that in group C(p=0.018).7.Comparison of POCD incidence.According to MMSE score,the total incidence of POCD in 5 groups was 34.57% 3 days after operation.The incidence of POCD in group A,B,C,D,E,was 18.92%,26.67%,35.14%,45.95%,52.38%,respectively.The difference was statistically significant(p=0.042).The incidence of POCD in group D and E was higher than that in group A.The incidence of group D was greater than that of group A(p=0.013).The incidence in group E was significantly higher than that in group A(p=0.008).The total incidence of POCD at 5 days after operation was23.46%.The incidence of POCD in group A,B,C,D,E was 8.11%,16.67%,24.32%,32.43%,42.86%,respectively.The difference was statistically significant(p=0.002).The incidence of POCD in group D and E were higher than that in group A.The incidence in group D was higher than that in group A(p=0.009).The incidence in group E was significantly higher than that in group A(p=0.005).The incidence of POCD in group E was higher than that in group B(p= 0.039).According to MoCA score,the total incidence of POCD in the 5 groups was37.04% 3 days after operation.The incidence of POCD in group A,B,C,D,E,was21.62%,26.67%,37.84%,48.65%,57.14%,respectively.The difference was statistically significant(p=0.027).The incidence of POCD in group D and E were higher than that in group A.The incidence of group D is greater than that of group A(p=0.015).The incidence in group E was significantly higher than that in group A(p= 0.006).The incidence of POCD in group E was higher than that in group B(p=0.028).The total incidence of POCD at 5 days after operation was 23.46%.The incidence of POCD in group A,B,C,D,E,was 8.11%、16.67%、21.62%、35.14%、42.86%,respectively.The difference was statistically significant(p=0.012).The incidence of POCD in group D and E was higher than that in group A.The incidence in group D was higher than that in group A(p=0.005).The incidence in group E was significantly higher than that in group A(p=0.005).The incidence in group E was higher than that in group B(p=0.039).8.The rates of POCD which were diagnosed by two scoring scales were compared.The incidence of POCD was similar at 3 days and 5 days after operation between the two scales(MMSE and MoCA).9.The risk factors of POCD incidence were analyzed.Logistic regression analysis of risk factors for the incidence of POCD showed that the risk factor for POCD in elderly patients 3 days after operation was the way of living.The risk factors of POCD5 days after operation included living style and preoperative cognitive impairment.Conclusion:Living style affects the incidence of POCD in the near future after operation.Elderly patients were more likely to have POCD by living in a nursing home or living alone before surgery than other living style. |
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