International Journal of Medicine and Medical Sciences

International Journal of Medicine and Medical Sciences | Vol. 16, No. 6, June 2026 | pp. 57–64

DOI: 10.46882/2026/IJMMS/160051

Original Research Article

Evaluation of Regional Cerebral Oxygen Saturation using Near-Infrared Spectroscopy versus Mean Arterial Pressure for Predicting Postoperative Cognitive Dysfunction in Elderly Patients

Charles O. Igwe¹, Rachel L. Sanon², Anthony D. Boateng¹*

¹Department of Anesthesiology and Intensive Care, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria.

²Department of Surgery, Faculty of Health Sciences, Université de Ouagadougou, Ouagadougou, Burkina Faso.

Abstract:

Postoperative cognitive dysfunction (POCD) is a frequent and serious complication in elderly patients undergoing major surgery, but relying on standard systemic hemodynamic parameters like mean arterial pressure (MAP) often fails to detect localized cerebral hypoperfusion. This prospective observational study evaluated the utility of continuous regional cerebral oxygen saturation (rScO₂) monitoring via Near-Infrared Spectroscopy (NIRS) compared to intraoperative MAP tracking for predicting early POCD. We evaluated 130 elderly patients (aged ≥ 65 years) undergoing major elective orthopedic or abdominal surgeries under general anesthesia. Intraoperative rScO₂ and MAP variations were recorded, and cognitive function was assessed preoperatively and on postoperative day 7 using a standardized neuropsychological test battery. Severe intraoperative cerebral desaturation was defined as a decrease in rScO₂ > 20% from baseline lasting for ≥ 15 minutes. A total of 24 patients developed confirmed early POCD (18.5%). In the POCD cohort, the mean intraoperative rScO₂ dropped significantly below baseline values during the maintenance phase, whereas mean intraoperative MAP remained within 20% of baseline targets for 83.3% of these patients, showing no predictive correlation. Receiver Operating Characteristic (ROC) analysis showed that a maximum intraoperative rScO₂ drop > 22% predicted day 7 POCD with a sensitivity of 87.5%, a specificity of 83.0%, and an Area Under the Curve (AUC) of 0.89 (95% CI = 0.82–0.95). Relying on systemic MAP alone is insufficient to protect the aging brain. Real-time NIRS monitoring offers an effective tool for detecting clinical cerebral desaturation events and guiding targeted anesthetic management to mitigate POCD risks.

Keywords: Postoperative Cognitive Dysfunction, Near-Infrared Spectroscopy, Cerebral Desaturation, Mean Arterial Pressure, Elderly Patients, Neuropsychological Testing

Manuscript Timeline: Received: March 20, 2026; Revised: April 28, 2026; Accepted: May 20, 2026; Published: June 25, 2026.

Citation: Igwe CO, Sanon RL, Boateng AD. Evaluation of Regional Cerebral Oxygen Saturation using Near-Infrared Spectroscopy versus Mean Arterial Pressure for Predicting Postoperative Cognitive Dysfunction in Elderly Patients. International Journal of Medicine and Medical Sciences, 2026, 16(6): 57–64. DOI: 10.46882/2026/IJMMS/160051

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