Postoperatives kognitives Defizit bei alten Patienten

 

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Zusammenfassung

Postoperative kognitive Defizite treten vor allem bei älteren Patienten nach großen chirurgischen Eingriffen auf und beeinflussen die Morbidität und Mortalität dieser Patienten. Die Diagnose kann durch klinische Beobachtung und Durchführung neuropsychologischer Tests gestellt werden. Da bisher keine medikamentösen Therapieansätze der postoperativen kognitiven Störungen existieren, ist bei Risikopatienten die perioperative Durchführung präventiver Maßnahmen essenziell.

Abstract

Postoperative congnitive dysfunction occurs in geriatric patients after major operations and influences morbidity and mortality of these patients. Clinical observations and neuropsychological tests can be used to diagnose cognitive disorders after an operation. Until today no specific medical treatment is known for the therapy of cognitive dysfunctions after an operation and, therefore, in high risk patients perioperative preventive measures is the only way to decrease the incidence and extend of this disease.

Kernaussagen

• Das postoperative kognitive Defizit ist vom postoperativen Delir zu unterscheiden.

• Die Morbidität und Mortalität geriatrischer Patienten wird durch das postoperative Auftreten von Kognitionsstörungen negativ beeinflusst.

• Es existieren patientenbezogene, operative und medikamentöse Risikofaktoren, die das Auftreten von postoperativen kognitiven Dysfunktionen begünstigen.

• Die Diagnostik von postoperativen kognitiven Defiziten ist diffizil und kann mittels genauer klinischer Beobachtung oder durch spezifische Tests durchgeführt werden.

• Es existieren keine Medikamente die gezielt postoperative Kognitionsstörungen therapieren können.

• Das Risiko des älteren Patienten, eine kognitive Dysfunktion zu entwickeln, sollte präoperativ abgeschätzt werden.

• Bei Patienten mit einem erhöhten Risiko für kognitive Störungen nach einer Operation müssen präventive Maßnahmen durchgeführt werden.

• Inwieweit der Einsatz von Dopaminrezeptorantagonisten, neueren atypischen Antipsychotika und Cholinesterasehemmern gerechtfertigt ist, kann noch nicht abschließend beurteilt werden.

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PD Dr. med. Kristin Engelhard
Univ.–Prof. Dr. med. Christian Werner

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