As life expectancies increase, so does the number of elderly people undergoing surgical procedures.    Recently, there has been growing about potential neurotoxicity of anesthetics and their role in post-operative cognitive decline.

Alzheimer's Disease(AD) is a devastating disease most commonly found in elderly people. It is manifested by severe memory loss, language problems, impaired decision making and affected activities of daily living.

In the absence of either a single coherent etiological model to explain the cause of Alzheimer's or an effective treatment, a consistent part of funding for research in AD is aimed at identifying risk factors as well as delaying the clinical manifestations of the disease.   In this context the question of the association between Alzheimer's and anesthesia has again been raised.  Biophysical and animal model studies identified molecular changes simulating Alzheimer's disease (AD) pathology after exposure to inhaled anesthetics. 

A supplement to the Journal of Alzheimer's Disease on "Anesthetics and Alzheimer's Disease" discusses various aspects of the pathophysiology of AD and the role of anesthetics as a possible risk factor.  It covers:

  • Cellular and molecular pathology in AD
  • Influence of anesthetic size on Aβ oligomerization established using state-of-the-art NMR spectroscopic technique (a fundamental contribution in this area of research)
  • Evidence from animal model studies indicating more plaque formation in transgenic mice treated with inhaled anesthetics like halothane or isoflurane
  • Association between impairment of cholinergic neurons and cognitive deficits in AD patients; and the possible role of anesthetics in cholinergic dysfunction
  • Multifactorial etiology, including the type of anesthesia, apolipoprotein E genotype, and the presence of co-morbid disorders, in the development of long-term post-operative cognitive decline
  • Anesthesia in patients with dementia; noteworthy clinical antecedents and peri-operative risk management in AD

Guest Editors Drs. Mandal and Fodale emphasized that this update "is a cornerstone in the effort to update and clarify the possible linkages between common anesthetics given to millions of patients every day and the pathomechanism of AD, thus contributing to an ongoing constructive debate. The Editors of the supplement do not intend to engender a 'fear of anesthesia' that could lead to irrational rejection of surgery in later life, but they hope to encourage the earnest quest for the 'safe anesthetic' for the elderly and more research are warranted."