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La Presse Médicale
Volume 47, Issue 4, Part 2,
, Pages e45-e51
Cognitive complications are common after surgery in the elderly, and with an increased number of elderly patients undergoing surgery, a potential impact of anaesthesia and surgery on long term cognition, and especially dementia would be concerning. The question whether anaesthesia and surgery in itself induce structural changes in the brain and thereby cognitive deterioration, or reveal a preexisting cognitive impairment remains unresolved. Several studies show an increased risk of reversible cognitive impairment after surgery in the elderly, but the risk of inducing dementia remains speculative. Further studies are needed to elucidate this potential association. Meanwhile, elderly frail patients need to be closely followed including preoperative cognitive screening, since they are at increased risk of cognitive deterioration after surgery and discharge.
Impact of anaesthesia and surgery on cognition
It is estimated that three out of four adults have been exposed to general anaesthesia at least once, and that 10% of the population is undergoing surgery every year in developed countries . Cognitive impairment is a common complication after surgery in the elderly, as they are more vulnerable due to a decreased cognitive reserve . Additionally the risk of dementia increases with an advanced age . With an aging population, and an increased number of patients undergoing surgery, a
Dementia is a common condition in the elderly population, with an estimated prevalence of 8% in persons above 65years and up to 33% of persons above 85years of age in parts of the western world , , . The most important risk factor for developing dementia is increasing age . Several types of dementia exist, and different etiological factors are linked to each one of them. The most common form of dementia is Alzheimer's disease, and it is estimated that around 60% of cases are
Various cognitive complications after surgery
A number of different types of cognitive impairments after anaesthesia and surgery have been proposed, although the exact relation between anaesthesia and surgery and the cognitive decline is not always well established (box 2). Emergence after anaesthesia is the transition from unconsciousness to being fully awake, and usually this phase is smooth. Inadequate emergence is on the other hand a condition of disturbed activity level in the immediate postoperative period. Inadequate emergence and
Limitations of current evidence
It is well established that cognitive deterioration is a common phenomenon in elderly surgical patients but the relationship with dementia is not simple to assess. The methodology applied in POCD research usually includes a preoperative test to assess baseline performance, and a postoperative test to find out if deterioration from baseline has occurred. Thus, the studies do not include the patients’ or the relatives’ impression or an evaluation of level of functioning, such as activities of
Cognitive deterioration after surgery is a common complication after surgery in the elderly, and with an increasing number of elderly patients undergoing surgery, a potential impact of anaesthesia and surgery on the incidence of dementia would be concerning. Currently, we are unaware whether anaesthesia and surgery in itself induce or accelerate structural changes in the brain with a resulting cognitive deterioration, or if anaesthesia and surgery reveal a preexisting cognitive deterioration
L.S.R. has received financial support from the Trygfoundation.
Disclosure of interest
the authors declare that they have no competing interest.
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(2013)(Video) Anesthesia and Incident Dementia: A Population-Based Nested Case-Control Study
Early onset dementia: clinical and social aspects
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Br J Psychiatry
Preexisting cognitive impairment is associated with postoperative cognitive dysfunction after hip joint replacement surgery
Risk factors for inadequate emergence after anesthesia: emergence delirium and hypoactive emergence
Cited by (6)
- Patient-related and anesthesia-dependent determinants for postoperative delirium after oral and maxillofacial surgery. Results from a register-based case-control study
2021, Journal of Stomatology, Oral and Maxillofacial Surgery
To identify risk factors for postoperative delirium (POD) after general oral and maxillofacial surgery.
2420patients were screened postoperatively for POD using the Nursing Delirium Screening Scale (NuDESC) before discharge from the post anesthesia caring unit(PACU). Basic health data and risk factors were collected. For analysis the study group (n=41) was compared to a control group of 164randomly selected patients (case-control-ratio=1:4). To identify risk factors for POD multivariable logistic regression models were used. To see whether estimations remain stable, regression analysis was repeated for the subgroup of patients not undergoing dentoalveolar surgery (n=105). To estimate the risk for dentoalveolar surgery a logistic regression model was performed.
Dementia was the only significant risk factor for POD (Odds ratio 41.5; 95% CI 5.48–314), also for patients undergoing other than dentoalveolar surgery (58.1; 1.70–1983). Patients undergoing dentoalveolar surgery were more often suffering from dementia (35.5; 2.85–441), other psychiatric and neurological disorders (3.15; 1.05–9.43), were of younger age (0.97; 0.94–1.00) and had higher anesthesiological risk (3.95; 1.04–14.9).
Patients with dementia are at higher risk to develop POD after oral and maxillofacial surgery. We found a strong interdependence between age, dementia, ASA-Score and dentoalveolar surgery.
Risk of Dementia According to Surgery Type: A Nationwide Cohort Study
2022, Journal of Personalized Medicine
Postoperative cognitive dysfunction in patients with brain tumor
2021, Medical Journal of Peking Union Medical College Hospital
A toolbox for the longitudinal assessment of healthspan in aging mice
2020, Nature Protocols
Choosing anesthesia options for cataract surgery in patients with dementia
2019, Journal of Anaesthesiology Clinical Pharmacology
Postoperative cognitive disorders: An update
Recommended articles (6)
Research articleImpact on the brain of the inflammatory response to surgery
La Presse Médicale, Volume 47, Issue 4, Part 2, 2018, pp. e73-e81(Video) Anesthesia Considerations for Geriatric Patients
The brain is both the orchestrator as well as the target of the innate immune system's response to the aseptic trauma of surgery. When trauma-induced inflammation is not appropriately regulated persistent neuro-inflammation interferes with the synaptic plasticity that underlies the learning and memory aspects of cognition. The complications that ensue, include postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) at two poles of a constellation that is now termed perioperative neurocognitive disorders. While the relationship of acute POD to the more indolent POCD is not completely understood both can be further complicated by earlier-onset of dementia and higher mortality. How and why these disorders occur is the focus of this report. The innate immune system response to peripheral trauma signals to the brain through a regulated cascade of cellular and molecular actors producing a teleological defense mechanism, “sickness behavior,” to curtail further injury and initiate repair. Sickness behavior, including disordered cognition, is terminated by neural and humoral pathways that restore homeostasis and launch the organism on a path to good health. With so many “moving parts” the innate immune system is vulnerable in clinical settings that include advanced age and lifestyle-induced diseases such as “unhealthy” obesity and the inevitable insulin resistance. Under these conditions, inflammation may become exaggerated and long-lived. Consideration is provided how to identify the high-risk surgical patient and both pharmacological (including biological compounds) and non-pharmacological strategies to customize care.
Research articleRotational thromboelastometry in young, previously healthy patients with SARS-Cov2
Journal of Clinical Anesthesia, Volume 67, 2020, Article 110038
Research articleTools to screen and measure cognitive impairment after surgery and anesthesia
La Presse Médicale, Volume 47, Issue 4, Part 2, 2018, pp. e65-e72
Cognition is essential to all aspects of our everyday life. Although we take our cognitive function for granted, the perioperative period is prone to several aggressions that might impair it. Postoperative cognitive dysfunction, has been the aim of many studies recently, and was shown to be very common with an incidence that can reach 40%, yielding not only impairment in cognition, but also longer hospital stays, higher costs and greater mortality. While several studies have revealed some of the mechanisms contributing to postoperative cognitive dysfunction, the search for the perfect instrument to screen and measure cognitive (dys)function has proven more elusive. The present paper aims to review several cognitive evaluation methods, discussing their advantages and disadvantages as well as their potential clinical applications in evaluating the dynamics of the recovery of cognitive function after anesthesia and surgery. The current availability of easy to use computerized tests might provide the tools necessary to identify patients at risk, and promptly provide them with the adequate course of action.
Research articleHereditary vulnerabilities to post-operative cognitive dysfunction and dementia
Progress in Neuro-Psychopharmacology and Biological Psychiatry, Volume 47, 2013, pp. 128-134
In view of multiple prospective investigations reporting an incidence of 10% or greater in elderly patients after cardiac and non-cardiac procedures, it is surprising that no families, twins or even individual cases have been reported with persistent post-operative cognitive dysfunction (POCD) or post-operative dementia (POD) that is otherwise unexplained. As POCD and POD research has shifted in recent years from surgical and anesthetic variables to predictors of intrinsic, patient-specific susceptibility, a number of markers based on DNA sequence variation have been investigated. Nevertheless, no heritable, genomic indices of persistent POCD or post-operative dementia lasting 3months or longer after surgery have been identified to date. The present manuscript surveys challenges confronting the search for markers of heritable vulnerability to POCD and POD, and proposes steps forward to be taken now, including the addition of surgical and anesthetic descriptors to ongoing longitudinal dementia protocols and randomized clinical trials (RCTs) comprising serial psychometric testing, and a fresh focus on phenotypes and genotypes shared between outliers with “extreme” POCD and POD traits.
Research articlePost-operative cognitive disorders: A new model for perioperative medicine
La Presse Médicale, Volume 47, Issue 4, Part 2, 2018, pp. e43-e44
Research articleEffect of intravenous infusion of dobutamine hydrochloride on the development of early postoperative cognitive dysfunction in elderly patients via inhibiting the release of tumor necrosis factor-α
European Journal of Pharmacology, Volume 741, 2014, pp. 150-155
To investigate the effects of dobutamine hydrochloride on early postoperative cognitive dysfunction (POCD) and plasma tumor necrosis factor (TNF)-α concentration in patients undergoing hip arthroplasty, 124 patients undergoing unilateral total hip arthroplasty, aged 70–92 years old, were randomly assigned to four groups (n=31) as follows: a control group of patients receiving only saline (intravenous infusion, i.v.); and groups receiving 2, 4, or 6μgkg−1min−1 (i.v.) of dobutamine hydrochloride. Cognitive functions were assessed on the day before surgery (T1), and the 1st day (T2), 3rd day (T3), and 7th day (T4) postsurgery using the Mini Mental State Examination (MMSE). The plasma TNF-α protein level was determined 10min before anesthesia (Ta), and 10min (Tb), 30min (Tc), and 60min (Td) after anesthesia by an enzyme-linked immunosorbent assay. Cognitive disorder was observed within the first 3 days after hip arthroplastic surgery, and it had recovered 7 days after the operation in the control group of patients. Administration of 2 or 4μgkg−1min−1 dobutamine hydrochloride was able to reverse the early POCD. Simultaneously, an increase of plasma TNF-α levels 30min after anesthesia was observed (41.34±9.61 vs. 27.75±5.45), which was significantly suppressed by the administration of low-dose dobutamine hydrochloride (29.23±7.32 vs. 41.34±9.61) but not by high-dose dobutamine hydrochloride (45.9±12.11 vs. 41.34±9.61). Together, our data indicated that the plasma concentration of TNFα was engaged in the effect of dobutamine hydrochloride on POCD.See AlsoUnlocking the Secrets of Serrapeptase and Scar TissueSerrapeptase : avantages, posologie, dangers et effets secondaires -Top 19 best apps to watch movies and TV shows on Android!What Does the Maid of Honor Do? MOH Duties List - Yeah Weddings(Video) Postoperative effects of anaesthesia on the brain
© 2018 Elsevier Masson SAS. All rights reserved.
Anesthesia and the risk of dementia in the elderly? ›
They found that general anaesthesia was associated with higher risks of dementia. The older the person when they had surgery the more likely they were to have a higher risk of dementia. The researchers suggested that older brains could be less resistant to damage caused by anaesthesia.Does anesthesia increase risk of dementia? ›
Researchers found no association between the type of anesthesia and dementia risk, according to findings published online Oct. 6, 2020, by the Journal of the American Geriatrics Society.Is there a link between anesthesia and Alzheimer's? ›
Alzheimer's disease (AD) patients appear to be particularly at risk of cognitive deterioration following anesthesia, and some studies suggest that exposure to anesthetics may increase the risk of AD.How does anesthesia affect the brain in the elderly? ›
Anesthesia, surgery linked to subtle decline in memory and thinking in older adults, Mayo study finds. ROCHESTER, Minn. — In adults over 70, exposure to general anesthesia and surgery is associated with a subtle decline in memory and thinking skills, according to new Mayo Clinic research.What are the risks of anesthesia in elderly? ›
However, elderly patients have some unique risks. Older patients are more prone to postoperative delirium, aspiration, urosepsis, adverse drug reactions, pressure ulcers, malnutrition, falls, and failure to return to ambulation or home.Can dementia be triggered by surgery? ›
The risk of dementia increased in patients who received intravenous or intramuscular anaesthesia, regional anaesthesia and general anaesthesia. The results of our nationwide, population-based study suggest that patients who undergo anaesthesia and surgery may be at increased risk of dementia.How long can anesthesia affect your memory? ›
On average, those who went under general anesthesia had small declines in their immediate memory over four years, compared with those who did not have.How long does dementia after surgery last? ›
Most cases of delirium last a week or less, with symptoms that gradually decline as the patient recovers from surgery. However, the condition can last for weeks or months in patients with underlying memory or cognitive challenges such as dementia, vision, or hearing impairment, or a history of post-operative delirium.Can anesthesia cause memory loss in elderly? ›
In fact, half of all people 65 and older will have at least one surgical procedure in their lifetime. And along with common potential side effects from anesthesia during surgery such as nausea, chills or muscle aches and itching, older patients are at risk for confusion or short-term memory loss.How do you reverse memory loss after anesthesia? ›
The new findings strongly suggest that the alpha-5 GABA type A receptors are "necessary for the development" of anesthesia-related memory deficits. They also suggest that drugs to block those receptors are a "plausible strategy for reversing memory deficits after general anesthesia," the researchers write.
Can anesthesia cause memory issues? ›
Researchers conclude that middle-aged people have a higher risk of memory loss and cognition decline after undergoing surgical anesthesia. You might expect to get temporarily knocked out by general anesthesia during surgery, but new research has found that it may have lasting impacts on memory and cognition.What are the long-term side effects of anesthesia after surgery? ›
- Postoperative delirium. Some people may become confused, disoriented, or have trouble remembering things after surgery. ...
- Postoperative cognitive dysfunction (POCD). Some people may experience ongoing memory problems or other types of cognitive impairment after surgery.
Summary: Researchers have shown why anesthetics can cause long-term memory loss, a discovery that can have serious implications for post-operative patients.Who should not get general anesthesia? ›
Your anesthesia risk might be higher if you have or have ever had any of the following conditions: Allergies to anesthesia or a history of adverse reactions to anesthesia. Diabetes. Heart disease (angina, valve disease, heart failure, or a previous heart attack)Can an 80 year old survive surgery? ›
Overall, we have shown that age should not be a disqualifying factor for emergency surgery in those aged >80 years. Most patients who underwent surgery had ASA ≥III and multiple comorbidities, but the majority survived 30 days after surgery.Does general anesthesia cause cognitive decline? ›
Cognitive disturbance is commonly observed in elderly patients following surgery and general anesthesia and is predictive of short- and long-term outcomes. Cognitive disorders include postoperative delirium (POD) and postoperative cognitive dysfunction (POCD).How long does post operative cognitive decline last? ›
Postoperative cognitive dysfunction (POCD) is a decline in cognitive function (especially in memory and executive functions) that may last from 1–12 months after surgery, or longer. In some cases, this disorder may persist for several years after major surgery. POCD is distinct from emergence delirium.Can surgery trigger Alzheimer's? ›
— Older adults who have surgery with general anesthesia may experience a modest acceleration of cognitive decline, even years later. But there's no evidence of a link to Alzheimer's disease, according to new research from Mayo Clinic.Does general anesthesia cause cognitive decline? ›
Cognitive disturbance is commonly observed in elderly patients following surgery and general anesthesia and is predictive of short- and long-term outcomes. Cognitive disorders include postoperative delirium (POD) and postoperative cognitive dysfunction (POCD).How long does dementia after surgery last? ›
Most cases of delirium last a week or less, with symptoms that gradually decline as the patient recovers from surgery. However, the condition can last for weeks or months in patients with underlying memory or cognitive challenges such as dementia, vision, or hearing impairment, or a history of post-operative delirium.
Does anesthesia cause short-term memory loss? ›
Short-term memory disorder following surgery and anesthesia is a common complication of anesthesia and a common complaint of the patients.