Anesthesiology and cognitive impairment: a narrative review of current clinical literature

BMC Anesthesiology

Table 1 Nomenclature used for cognitive impairment at different perio-operative time periods

Time Period	Nomenclature	Definition
Preoperative	Mild Neurocognitive Disorder (NCD)	DSM-5 definition: (1) cognitive concern from the individual/informant/clinician + (2) objective evidence of decline of 1–2 SD compared to normative group + (3) maintained iADLs &/or ADLs
Preoperative	Major NCD	DSM-5 definition: (1) cognitive concern from the individual/informant/clinician + (2) objective evidence of decline of ≥2 SD + (3) impaired iADLs &/or ADLs
Emergence	Emergence excitation or delirium
After operation to postoperative day 30	Postoperative delirium	Fluctuating changes in attention, mental status, or level of consciousness which occur in hospital up to 1 week following surgery
After operation to postoperative day 30	Delayed neurocognitive recovery	Cognitive decline meeting DSM-5 criteria for mild or major NCD, diagnosed within the 30 day recovery period
From expected recovery (30 days) to 12 months	Postoperative mild neurocognitive disorder (POCD) Postoperative major NCD (POCD)	Criteria as per DSM-5 for mild and major NCD Assumes decline cannot be accounted for by any other condition. Postoperative specifier implies temporal relationship. It does not imply causation. POCD is included as a specifier in parentheses while transitioning to the new nomenclature
Greater than 12 months postoperatively	Routine DSM-5 nomenclature	Postoperative specifier is NO LONGER attached if neurocognitive disorder is first diagnosed after this time.

The above nomenclature has been recently proposed to further define neurocognitive disorders associated with the perioperative period. Abbreviations: DSM-5 diagnostic and statistical manual of mental disorders, NCD neurocognitive disorder, SD standard deviation, iADL instrumental activities of daily living, ADL activities of daily living; Objective evidence: tests of complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition. Objective evidence cannot be limited to screening tools. This table is adapted from Evered et al. (2018) [7]

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