Understanding neurocognitive recovery in older adults after total hip arthroplasty—neurocognitive assessment, blood biomarkers and patient experiences: a mixed-methods study
Objective Delayed neurocognitive recovery, previously known as postoperative cognitive dysfunction, is a common complication affecting older adults after surgery. This study aims to address the knowledge gap in postoperative neurocognitive recovery by exploring the relationship between subjective ex...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/1/e093872.full |
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| author | Ulrica Nilsson Karin Liander Lina Bergman Anahita Amirpour Jeanette Eckerblad Gabriela Markovic |
| author_facet | Ulrica Nilsson Karin Liander Lina Bergman Anahita Amirpour Jeanette Eckerblad Gabriela Markovic |
| author_sort | Ulrica Nilsson |
| collection | DOAJ |
| description | Objective Delayed neurocognitive recovery, previously known as postoperative cognitive dysfunction, is a common complication affecting older adults after surgery. This study aims to address the knowledge gap in postoperative neurocognitive recovery by exploring the relationship between subjective experiences, performance-based measurements, and blood biomarkers.Design Mixed-methods study with a convergent parallel (QUAL+quan) design.Setting and participants The study reports results from 40 older adult patients (52.5% women; mean age 73, SD 6.7) scheduled for total hip arthroplasty at a hospital in Sweden.Outcome measures Neurocognitive performance was assessed using a standardised test battery, neuroinflammation through blood biomarker analysis and postoperative neurocognitive recovery via semistructured interviews and the Swedish Quality of Recovery questionnaire.Results Five patients were classified as having delayed neurocognitive recovery based on performance tests. Qualitative data revealed that most patients reported cognitive symptoms, particularly related to executive functions and fatigue. Psychological factors, including a sense of agency and low mood, significantly influenced cognitive recovery and daily functioning. Elevated inflammatory blood biomarkers were not detected pre- or postoperatively in patients with delayed neurocognitive recovery. The global postoperative recovery score was 40.9, indicating a low quality of recovery.Conclusion Many patients reported subjective cognitive decline that was not corroborated by delayed neurocognitive recovery in the performance-based tests. Psychological factors were influential for neurocognitive recovery and should be routinely assessed. Future research should incorporate longitudinal follow-ups with performance-based measurements, fatigue assessment, evaluations of instrumental activities of daily living and subjective reporting, supported by a multidisciplinary team approach.Trial registration number NCT05361460. |
| format | Article |
| id | doaj-art-f5b23dd2bf48431da784abbc139ab96f |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-f5b23dd2bf48431da784abbc139ab96f2025-01-30T08:25:08ZengBMJ Publishing GroupBMJ Open2044-60552025-01-0115110.1136/bmjopen-2024-093872Understanding neurocognitive recovery in older adults after total hip arthroplasty—neurocognitive assessment, blood biomarkers and patient experiences: a mixed-methods studyUlrica Nilsson0Karin Liander1Lina Bergman2Anahita Amirpour3Jeanette Eckerblad4Gabriela Markovic51 Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden4 Perioperative Medicine Intensive Care, Karolinska Universitetsjukhuset i Huddinge, Huddinge, Sweden1 Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden1 Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden1 Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden2 Department of Clinical Sciences, Karolinska Institutet, Stockholm, SwedenObjective Delayed neurocognitive recovery, previously known as postoperative cognitive dysfunction, is a common complication affecting older adults after surgery. This study aims to address the knowledge gap in postoperative neurocognitive recovery by exploring the relationship between subjective experiences, performance-based measurements, and blood biomarkers.Design Mixed-methods study with a convergent parallel (QUAL+quan) design.Setting and participants The study reports results from 40 older adult patients (52.5% women; mean age 73, SD 6.7) scheduled for total hip arthroplasty at a hospital in Sweden.Outcome measures Neurocognitive performance was assessed using a standardised test battery, neuroinflammation through blood biomarker analysis and postoperative neurocognitive recovery via semistructured interviews and the Swedish Quality of Recovery questionnaire.Results Five patients were classified as having delayed neurocognitive recovery based on performance tests. Qualitative data revealed that most patients reported cognitive symptoms, particularly related to executive functions and fatigue. Psychological factors, including a sense of agency and low mood, significantly influenced cognitive recovery and daily functioning. Elevated inflammatory blood biomarkers were not detected pre- or postoperatively in patients with delayed neurocognitive recovery. The global postoperative recovery score was 40.9, indicating a low quality of recovery.Conclusion Many patients reported subjective cognitive decline that was not corroborated by delayed neurocognitive recovery in the performance-based tests. Psychological factors were influential for neurocognitive recovery and should be routinely assessed. Future research should incorporate longitudinal follow-ups with performance-based measurements, fatigue assessment, evaluations of instrumental activities of daily living and subjective reporting, supported by a multidisciplinary team approach.Trial registration number NCT05361460.https://bmjopen.bmj.com/content/15/1/e093872.full |
| spellingShingle | Ulrica Nilsson Karin Liander Lina Bergman Anahita Amirpour Jeanette Eckerblad Gabriela Markovic Understanding neurocognitive recovery in older adults after total hip arthroplasty—neurocognitive assessment, blood biomarkers and patient experiences: a mixed-methods study BMJ Open |
| title | Understanding neurocognitive recovery in older adults after total hip arthroplasty—neurocognitive assessment, blood biomarkers and patient experiences: a mixed-methods study |
| title_full | Understanding neurocognitive recovery in older adults after total hip arthroplasty—neurocognitive assessment, blood biomarkers and patient experiences: a mixed-methods study |
| title_fullStr | Understanding neurocognitive recovery in older adults after total hip arthroplasty—neurocognitive assessment, blood biomarkers and patient experiences: a mixed-methods study |
| title_full_unstemmed | Understanding neurocognitive recovery in older adults after total hip arthroplasty—neurocognitive assessment, blood biomarkers and patient experiences: a mixed-methods study |
| title_short | Understanding neurocognitive recovery in older adults after total hip arthroplasty—neurocognitive assessment, blood biomarkers and patient experiences: a mixed-methods study |
| title_sort | understanding neurocognitive recovery in older adults after total hip arthroplasty neurocognitive assessment blood biomarkers and patient experiences a mixed methods study |
| url | https://bmjopen.bmj.com/content/15/1/e093872.full |
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