Defense Date


Document Type


Degree Name

Doctor of Philosophy


Pharmaceutical Sciences

First Advisor

Patricia Slattum


Background: Postoperative cognitive dysfunction (POCD) is a deterioration in cognitive function that occurs after surgery as measured by neuropsychological tests. The purpose of this study was to determine the incidence and risk factors for POCD in older adults three months after major noncardiac surgery. Methods: This is a prospective study of patients aged 65 years and older who underwent major noncardiac surgery. Patients’ cognitive function was assessed before and three months after surgery using a computerized neurocognitive battery. Blood samples were withdrawn from patients before surgery to identify patients with high level of C-reactive protein (CRP), and patients who had the apolipoprotein-E4 (ApoE4) allele, as potential inflammatory and genetic biomarkers for POCD, respectively. A nonsurgical control group, that is similar to patients in age, education level, and computer familiarity, was recruited to adjust for learning effects from repeated administration of neurocognitive tests. Patients were classified as having POCD if they had less than -1.96 in the individual Z-scores of two or more tests or in the composite Z-score. Results: A total of 69 patients and 54 controls completed the study. The mean age for patients was 71 ± 5.4 (65–88) years old and 66.7% of them were females. The majority of patients (78.3%) had above high school education. There was no difference between the surgical and nonsurgical groups in demographics except for age which was marginally higher in the nonsurgical group [73 ± 6.3 (65-92)]. The incidence of POCD was 15.9% three months after surgery. Multivariable logistic regression showed that carrying the ApoE4 allele (OR = 4.74, 95% CI = 1.09 – 22.19), using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery (OR = 5.64, 95% CI = 1.35 – 30.22), and receiving sevoflurane for anesthesia (OR = 6.43, 95% CI = 1.49 – 34.66) were risk factors for POCD. Conclusion: The incidence of POCD in older adults is 15.9% three months after major noncardiac surgery. Risk factors for POCD were carrying the ApoE4 allele, using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery, and receiving sevoflurane for anesthesia.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

May 2013