General anesthetic and the risk of dementia in elderly patients: current insights

Maria Hussain,1 Miles Berger,2 Roderic G Eckenhoff,3 Dallas P Seitz1 1Division of Geriatric Psychiatry, Department of Psychiatry, Queen’s University; 2Anesthesiology Department, Duke University Medical Center, Durham, NC, USA; 3Department of Anesthesiology and Critical Care, Univ...

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Autores principales:	Hussain M, Berger M, Eckenhoff RG, Seitz DP
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	surgery general anesthetic anesthesia dementia Alzheimers disease Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/3d386d8a927a40ca8e0af49f75aa502a
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spelling	oai:doaj.org-article:3d386d8a927a40ca8e0af49f75aa502a2021-12-02T00:29:41ZGeneral anesthetic and the risk of dementia in elderly patients: current insights1178-1998https://doaj.org/article/3d386d8a927a40ca8e0af49f75aa502a2014-09-01T00:00:00Zhttps://www.dovepress.com/general-anesthetic-and-the-risk-of-dementia-in-elderly-patients-curren-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Maria Hussain,1 Miles Berger,2 Roderic G Eckenhoff,3 Dallas P Seitz1 1Division of Geriatric Psychiatry, Department of Psychiatry, Queen’s University; 2Anesthesiology Department, Duke University Medical Center, Durham, NC, USA; 3Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Abstract: In this review, we aim to provide clinical insights into the relationship between surgery, general anesthesia (GA), and dementia, particularly Alzheimer’s disease (AD). The pathogenesis of AD is complex, involving specific disease-linked proteins (amyloid-beta [Aß] and tau), inflammation, and neurotransmitter dysregulation. Many points in this complex pathogenesis can potentially be influenced by both surgery and anesthetics. It has been demonstrated in some in vitro, animal, and human studies that some anesthetics are associated with increased aggregation and oligomerization of Aß peptide and enhanced accumulation and hyperphosphorylation of tau protein. Two neurocognitive syndromes that have been studied in relation to surgery and anesthesia are postoperative delirium and postoperative cognitive dysfunction, both of which occur more commonly in older adults after surgery and anesthesia. Neither the route of anesthesia nor the type of anesthetic appears to be significantly associated with the development of postoperative delirium or postoperative cognitive dysfunction. A meta-analysis of case-control studies found no association between prior exposure to surgery utilizing GA and incident AD (pooled odds ratio =1.05, P=0.43). The few cohort studies on this topic have shown varying associations between surgery, GA, and AD, with one showing an increased risk, and another demonstrating a decreased risk. A recent randomized trial has shown that patients who received sevoflurane during spinal surgery were more likely to have progression of preexisting mild cognitive impairment compared to controls and to patients who received propofol or epidural anesthesia. Given the inconsistent evidence on the association between surgery, anesthetic type, and AD, well-designed and adequately powered studies with longer follow-up periods are required to establish a clear causal association between surgery, GA, and AD. Keywords: surgery, anesthesia, Alzheimer’s diseaseHussain MBerger MEckenhoff RGSeitz DPDove Medical Pressarticlesurgerygeneral anestheticanesthesiadementiaAlzheimers diseaseGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 1619-1628 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	surgery general anesthetic anesthesia dementia Alzheimers disease Geriatrics RC952-954.6
spellingShingle	surgery general anesthetic anesthesia dementia Alzheimers disease Geriatrics RC952-954.6 Hussain M Berger M Eckenhoff RG Seitz DP General anesthetic and the risk of dementia in elderly patients: current insights
description	Maria Hussain,1 Miles Berger,2 Roderic G Eckenhoff,3 Dallas P Seitz1 1Division of Geriatric Psychiatry, Department of Psychiatry, Queen’s University; 2Anesthesiology Department, Duke University Medical Center, Durham, NC, USA; 3Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Abstract: In this review, we aim to provide clinical insights into the relationship between surgery, general anesthesia (GA), and dementia, particularly Alzheimer’s disease (AD). The pathogenesis of AD is complex, involving specific disease-linked proteins (amyloid-beta [Aß] and tau), inflammation, and neurotransmitter dysregulation. Many points in this complex pathogenesis can potentially be influenced by both surgery and anesthetics. It has been demonstrated in some in vitro, animal, and human studies that some anesthetics are associated with increased aggregation and oligomerization of Aß peptide and enhanced accumulation and hyperphosphorylation of tau protein. Two neurocognitive syndromes that have been studied in relation to surgery and anesthesia are postoperative delirium and postoperative cognitive dysfunction, both of which occur more commonly in older adults after surgery and anesthesia. Neither the route of anesthesia nor the type of anesthetic appears to be significantly associated with the development of postoperative delirium or postoperative cognitive dysfunction. A meta-analysis of case-control studies found no association between prior exposure to surgery utilizing GA and incident AD (pooled odds ratio =1.05, P=0.43). The few cohort studies on this topic have shown varying associations between surgery, GA, and AD, with one showing an increased risk, and another demonstrating a decreased risk. A recent randomized trial has shown that patients who received sevoflurane during spinal surgery were more likely to have progression of preexisting mild cognitive impairment compared to controls and to patients who received propofol or epidural anesthesia. Given the inconsistent evidence on the association between surgery, anesthetic type, and AD, well-designed and adequately powered studies with longer follow-up periods are required to establish a clear causal association between surgery, GA, and AD. Keywords: surgery, anesthesia, Alzheimer’s disease
format	article
author	Hussain M Berger M Eckenhoff RG Seitz DP
author_facet	Hussain M Berger M Eckenhoff RG Seitz DP
author_sort	Hussain M
title	General anesthetic and the risk of dementia in elderly patients: current insights
title_short	General anesthetic and the risk of dementia in elderly patients: current insights
title_full	General anesthetic and the risk of dementia in elderly patients: current insights
title_fullStr	General anesthetic and the risk of dementia in elderly patients: current insights
title_full_unstemmed	General anesthetic and the risk of dementia in elderly patients: current insights
title_sort	general anesthetic and the risk of dementia in elderly patients: current insights
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/3d386d8a927a40ca8e0af49f75aa502a
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General anesthetic and the risk of dementia in elderly patients: current insights

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