Journal of Alzheimer's Disease - Volume 22, issue s3

Authors: Vanderweyde, Tara | Bednar, Martin M. | Forman, Stuart A. | Wolozin, Benjamin

Article Type: Review Article

Abstract: Increasing evidence indicates that patients develop post-operative cognitive decline (POCD) following surgery. POCD is characterized by transient short-term decline in cognitive ability evident in the early post-operative period. This initial decline might be associated with increased risk of a delayed cognitive decline associated with dementia 3 to 5 years post-surgery. In some studies, the conversion rates to dementia are up to 70% in patients who are 65 years or older. The factors responsible for the increased risk of dementia are unclear; however, clinical studies investigating the prevalence of POCD and dementia following surgery do not show an association with the …type of anesthesia or duration of surgery. Epidemiological studies from our group support this observation. The adjusted Hazard Ratios for developing dementia (or AD specifically) after prostate or hernia surgery were 0.65 (95% CI, 0.51 to 0.83, prostate) and 0.65 (95% CI, 0.49 to 0.85, hernia) for cohorts of subjects exposed to general anesthesia compared to those exposed only to local anesthesia. Animal studies suggest that prolonged exposure to some volatile-inhalational anesthetics increase production of amyloid-β and vulnerability to neurodegeneration, but these results are weakened by the absence of clinical support. Inflammation and a maladaptive stress response might also contribute to the pathophysiology of this disorder. Future research needs to identify predisposing factors, and then strategies to protect against POCD and subsequent dementia. The field also needs to adopt a more rigorous approach to codifying the frequency and extent of early and delayed post-operative cognitive decline. Show more

Keywords: Alzheimer's disease, amyloid-β protein, anesthetics, coronary artery bypass operation dementia, surgery

DOI: 10.3233/JAD-2010-100843

Citation: Journal of Alzheimer's Disease, vol. 22, no. s3, pp. S91-S104, 2010

Authors: Ancelin, Marie-Laure | de Roquefeuil, Guilhem | Scali, Jacqueline | Bonnel, François | Adam, Jean-François | Cheminal, Jean-Claude | Cristol, Jean-Paul | Dupuy, Anne-Marie | Carrière, Isabelle | Ritchie, Karen

Article Type: Research Article

Abstract: Cognitive dysfunction in the elderly commonly observed following anesthesia has been attributed to age-related neuronal changes exacerbated by pharmacotoxic effects. However, the extent to which these changes may persist following recovery from surgery is still largely unknown. This study investigates the long-term effects of anesthesia on cognitive functioning after orthopedic surgery in 270 elderly patients over the age of 65 who completed a computerized cognitive battery before and 8 days, 4 and 13 months after surgery. Their performance was compared to those of 310 elderly controls who completed the same neuropsychiatric evaluation at baseline and one-year interval. Multivariate analyses adjusted …for socio-demographic variables, depressive symptomatology, vascular pathology as well as baseline cognitive performance. We found early and transient post-operative decline in reaction time and constructional praxis. With regard to long-term changes we observed improvement compared to controls in most verbal tasks (probably due to learning effects). On the other hand, a clear dissociation effect was observed for several areas of visuospatial functioning which persisted up to the 13-month follow-up. This specific pattern of visuospatial deficit was found to be independent of apolipoprotein E genotype and closely resembles what has recently been termed vascular mild cognitive impairment, in turn associated with subtle sub-cortical vascular changes. The observation of only minor differences between persons operated by general and regional anesthesia makes it difficult to attribute these changes directly to the anesthetic agents themselves, suggesting that cognitive dysfunction may be attributable at least in part to peri-operative conditions, notably stress and glucocorticoid exposure. Show more

Keywords: Anesthesia, apolipoprotein E, mild cognitive impairment, post-operative cognitive decline

DOI: 10.3233/JAD-2010-100807

Citation: Journal of Alzheimer's Disease, vol. 22, no. s3, pp. S105-S113, 2010

Authors: Mehta, Yatin | Singh, Raveen

Article Type: Review Article

Abstract: Both short and long term cognitive changes occur after cardiac surgery but the pathophysiology of these neurobehavioral changes remain incompletely understood. The cause of cognitive decline is most likely multifactorial and probably represents a complex interaction between cerebral microemboli, global cerebral hypoperfusion, inflammation, and genetic susceptibility. The problem of cognitive decline after cardiac surgery continues to increase as the surgical population becomes older and has more prevalent comorbid diseases. A better understanding of the etiology is essential to finding new preventive strategies as no definitive therapy exists for cognitive dysfunction.

Keywords: Cardiac surgery, cardiopulmonary bypass, neurologic dysfunction, pathophysiology

DOI: 10.3233/JAD-2010-100834

Citation: Journal of Alzheimer's Disease, vol. 22, no. s3, pp. S115-S120, 2010

Authors: Di Nino, Gianfranco | Adversi, Marco | Dekel, Boaz G. Samolsky | Fodale, Vincenzo | Rosa, Giovanni | Melotti, Rita M.

Article Type: Research Article

Abstract: The aim of this review is to identify an evidence-based perioperative management for patients affected by Alzheimer's disease (AD) that are scheduled to undergo surgery. This will minimize the negative effects of anesthesia and postoperative sedation and correct those perioperative variables possibly responsible for a decline in cognitive status and a worsening of AD. We here gather evidence on the importance of correct preoperative assessment regarding cognitive and functional status and the presence of preoperative delirium. The potential role of anesthesia, surgery, and postoperative analgosedation as risk factors for development of delirium are herein outlined. Finally, pain assessment instruments, as …well as principles of management strategies for postoperative delirium in subjects with AD, are suggested. Show more

Keywords: Alzheimer's disease, anesthesia, anesthetics, delirium, dementia, pain, pain measurement, POCD, postoperative

DOI: 10.3233/JAD-2010-101299

Citation: Journal of Alzheimer's Disease, vol. 22, no. s3, pp. S121-S127, 2010

Authors: Funder, Kamilia S. | Steinmetz, Jacob | Rasmussen, Lars S.

Article Type: Review Article

Abstract: With a growing aging population, more patients suffering from dementia are expected to undergo surgery, thus being exposed to either general or regional anesthesia. This calls for specific attention ranging from the legal aspects of obtaining informed consent in demented patients to deciding on the use of premedication, choice of anesthetics, and management of postoperative pain. This review reflects on both general considerations concerning geriatric patients but also on the specific features of perioperatively used drugs and anesthetics that might have an impact on patients with Alzheimer's disease (AD).

Keywords: Aging, Alzheimer's disease, anesthesia, consent, postoperative pain

DOI: 10.3233/JAD-2010-100810

Citation: Journal of Alzheimer's Disease, vol. 22, no. s3, pp. S129-S134, 2010

Authors: Mandal, Pravat Kumar | Fodale, Vincenzo

Article Type: Editorial

DOI: 10.3233/JAD-2010-101300

Citation: Journal of Alzheimer's Disease, vol. 22, no. s3, pp. S135-S136, 2010