Bekker A, Korban A, Esochaghi S. Long-Term Cognitive Decline in the Elderly is not Attributable to Surgery/Anesthesia. Int J Anesth Res. 2017;5(10):490-493. 490 OPEN ACCESS http://scidoc.org/IJAR.php International Journal of Anesthesiology & Research (IJAR) ISSN 2332-2780 *Corresponding Author: Alex Bekker, M.D., Ph.D., Professor and Chair, Department of Anesthesiology, Professor, Department of Physiology and Pharmacology, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB E538, Newark, NJ, 07103, USA. Tel: 201-919-1032/973-972-5007 Fax: 973-972-0582 E-mail: bekkeray@njms.rutgers.edu Received: November 25, 2017 Accepted: December 19, 2017 Published: December 20, 2017 Citation: Bekker A, Korban A, Esochaghi S. Long-Term Cognitive Decline in the Elderly is not Attributable to Surgery/Anesthesia. Int J Anesth Res. 2017;5(10):490-493. doi: http://dx.doi.org/10.19070/2332-2780-1700099 Copyright: Bekker A © 2017. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. Introduction Cognitive function is an important outcome measure of surgi- cal intervention that affects patient well-being and function. It is expected that surgery would improve quality of life. However, a preponderance of literature during the last two decades ques- tions this precept and suggest that “surgery may heal the body but harm the brain” especially among the elderly patients [1]. As the number of publications on a subject of postoperative cogni- tive dysfunction (POCD) has dramatically increased, the concept become a “hot topic” among the anesthesiologists. It appears, however, that this postoperative complication (either perceived or real) is not an issue widely recognized by surgeons or other specialists. Surgical volume continues to grow, particularly in the elderly. It increased from 226 million operations in 2004 to 313 million operation in 2012 [2]. Clearly, concerns regarding POCD played minimal if any role in patients/surgeons decision to pro- ceed with the surgery. Moreover, recent more carefully conducted research indicates that surgery may actually improve cognition in the majority of patients [3, 4]. The objection of this narrative is to critically evaluate the POCD literature and assess clinical implica- tions of the phenomena if it indeed exists. Drawbacks of POCD Research POCD is deined as a decline in cognitive performance arising after surgical procedure. Its diagnosis requires both preoperative psychometric testing (baseline) and an arbitrary deinition of how much of a decline is called cognitive dysfunction. The testing, however, rarely performed outside of research setting. Neither ICD10 nor DSM V recognized POCD as a clinical state. Cur- rently there is no nomenclature or diagnostic criteria for this con- dition. Criteria for POCD typically rests on a battery of neurobehavioral assessments that measure various cognitive domains. Tests vary from complex combinations of neuropsychological measures (e.g. Hopkins Verbal Learning Tests, Visuospatial Learning Test, various subtests from Wechsler Adult Intelligence Scale, etc.) to simple Mini Mental Exam (MMSE). Long-Term Cognitive Decline in the Elderly is not Attributable to Surgery/Anesthesia Research Article Bekker A * , Korban A, Esochaghi S Rutgers New Jersey Medical School, Newark, NJ, USA. Abstract Postoperative cognitive dysfunction (POCD) is a topic of special importance for elderly patients. Based upon the results of a combination of retrospective human studies, experiments in animals, and a number of prospective human studies, the anesthesia research community has advanced the notion that surgery/anesthesia might precipitate permanent incident dementia. A careful analysis of the data, however, reveals numerous methodological problems with the clinical trials that have examined long-term POCD, including the vague deinition of POCD, poorly matched controls (or lack of controls in some investigations), arbitrary diagnostic criteria, etc. More recent evidence suggests that the vast majority of patients without pre-existing disease recover cognition in the long term. In fact, there are studies that suggest that in some cases surgery improves cognitive functioning (e.g. carotid endarterectomy, weight reduction surgery, etc.). This report critically analyzes the methodological concerns of the older studies and presents current evidence rejecting the long-term POCD hypothesis. In addition, it reviews the pre-existing condi- tions that may result in long term POCD.