The Perioperative Neurocognitive Disorders

This is the first edition of a book on the topical subject of the perioperative neurocognitive disorders (PND), the newly defined terminology describing cognitive decline after surgery and anesthesia. This term aligns more closely with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) terminology for psychiatric diagnoses in the elderly. The book covers a key topic in the perioperative literature, given the ever-increasing number of elderly patients at risk of PND presenting for surgery, and the associated morbidity and health care burden of this relatively poorly understood postoperative complication. The book is intended to be read by perioperative medicine practitioners, neurologists, geriatricians, psychologists, and researchers in the field of cognitive disorders, but would also be useful to trainees in anesthesia and geriatric medicine. It contains a comprehensive review of the current literature on the subject. The editors—Roderic G. Eckenhoff, MD, and Niccolò Terrando, PhD—are experts on the effects of anesthesia and surgery on neuroinflammation and neurodegeneration. Thirty authors from the fields of Anesthesiology, Geriatrics, Psychiatry, Neuroscience, and Clinical and Health Psychology contribute to the book’s 16 chapters. In the preface, the editors set out the challenges faced in interpreting previous clinical research in the field due to the varying definitions and criteria used to define PND. It explains the reasoning behind, and process of developing the new clinical classification and outlines how the book addresses the current evidence base and clinical recommendations in the field. The book is divided into 4 sections. Each section or chapter could be read together or in isolation depending on the reader’s area of interest, as the authors use background and appropriate references to contextualize their commentary. Section 1 covers the disorders of postoperative cognitive function in detail, providing a review of the scientific literature on PND and suggested mechanisms for the effect of anesthesia and surgery, and outlining recommendations for future clinical research. Section 2 summarizes in vitro and animal study evidence covering the pathophysiology of PND and gives an in-depth overview of the use of animal models in this field of research, including methods of cognitive testing and their limitations. In section 3, we can read about the various techniques used in human research to diagnose PND, including cognitive testing, biomarkers, and neuroimaging and their utility in a scientific and clinical context. Clinical recommendations for the identification of PND, risk-reduction strategies, and management of patients at risk are outlined in the final section of the book. This section also covers the important issue of informed consent and assessment of capacity in the elderly patient, and consideration of PND as a material risk of which patients should be made aware during the preoperative decision-making process. Each chapter is well supported by tables, illustrations, and appropriate citations. The content is appropriately indexed, and the book is easy to navigate. There is a plate section containing high-quality color images of the functional imaging described in Chapter 13. The eBook can be accessed via Cambridge Core (Cambridge University Press) and contains the full content of the print version. Tables and figures are embedded in the text in a more reader-friendly format than the print version, and hyperlinks provide easy navigation. The plate section images are displayed in color and can be enlarged to view in more detail or downloaded as a PDF. In conclusion, this book highlights the advances (and gaps) in the current understanding of the etiology, diagnosis, and prevention of PND. The 2 sections of this book of greatest value to the practicing perioperative physician are Section 1 for its description of the current evidence-base on pathophysiology, features, etiology, and prevention strategies, and Section 4 for its practical advice for preoperative assessment and intraoperative management of patients at risk of PND. Unfortunately, this is the shortest section of the book at only 31 pages long, and the editors declare their optimism that this chapter will increase in length in future editions, as the current evidence-base grows. A running theme throughout the book is the lack of translation of results from preclinical research into clinical studies and the need for further randomized controlled clinical trial evidence to inform our assessment and management of the steadily increasing numbers of elderly patients undergoing major surgery. This book is a valuable addition to the literature and should also provide a stimulus for much needed further research in this area. Helen R. Doherty, MBBS, FRCAJean Wong, MD, FRCPCDepartment of AnesthesiaToronto Western HospitalToronto, Ontario, CanadaUniversity of TorontoToronto, Ontario, Canada[email protected]

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