Recommendations for the nomenclature of Cognitive change associated with anaesthesia and surgery-2018

L. Evered, B. Silbert, D. S. Knopman, D. A. Scott, S. T. DeKosky, L. S. Rasmussen, E. S. Oh, G. Crosby, M. Berger, R. G. Eckenhoff, Roderic G. Eckenhof, David Ames, Alex Bekker, Deborah Blacker, Jefrey Browndyke, Greg Crosby, Stacie G. Deiner, Diederik Van Dijk, Maryellen F. Eckenhof, Lars ErikssonDougas Galasko, Kirk Hogan, Sharon Inouye, David Knopman, Constantine Lyketsos, Edward Marcantonio, Paul Maruf, Mervyn Maze, Esther Oh, Beverley A. Orser, Tomas Ottens, Catherine Price, Lars S. Rasmussen, Perminder Sachdev, Katie Schenning, David A. Scott, Frederick E. Seiber, Brendan Silbert, Jef Silverstein, Jacob Steinmetz, Niccolo Terrando, Paula Trzapacz, Rob Whittington, Zhong Cong Xie

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


Cognitive change afecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identifed up to 7.5 yr afterwards. Importantly, other studies have identifed that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modifed Delphi procedure with no prespecifed number of rounds comprised of three face-to-face meetings followed by online editing of draft versions. Two major classification guidelines (Diagnostic and Statistical Manual for Mental Disorders, ffth edition [DSM-5] and National Institute for Aging and the Alzheimer Association [NIA-AA]) are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that 'perioperative neurocognitive disorders' be used as an overarching term for cognitive impairment identifed in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).

Original languageEnglish (US)
Pages (from-to)872-879
Number of pages8
Issue number5
StatePublished - Jan 1 2018


  • Cognition disorders
  • Delirium
  • Neurocognitive disorders
  • Postoperative complications

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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