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Can Anesthesia Cause Long Term Memory Loss

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Is There Any Evidence Of Anaesthesia Causing Memory Loss

Memory Loss Following Anesthesia Error; NY Medical Malpractice Attorney Oginski Explains

Lets look a little more into the phenomenon known as post operative cognitive dysfunction , as its a condition that has been researched closely.

Most of these POCD studies have focused on the elderly, because thats where this phenomenon is most commonly seen.

A 2001 paper in The New England Journal of Medicine kept track of patients who received coronary artery bypass surgery using a specific method where a heart-lung machine circulates and oxygenates the blood. The researchers found that many patients complained that they had a mental haziness after the surgery. According to the paper authors, more than half of the patients left the hospital with signs of cognitive decline and 42% were still impaired 5 years later.

Though critics were unsure whether the data was accurate, later studies revealed that the patients still developed cognitive difficulties at about the same rate whether they had pump or “off pump” surgery.

Other studies have reached different conclusions. For example, in February 2016, an anesthesiologist named Juraj Sprung of the Mayo Clinic and a team looked at the prevalence of mild cognitive impairment . MCI is essentially a mental downturn that often is a precursor to Alzheimer’s disease. The team compared how often MCI appeared in people who had undergone an operation or procedure that required general anaesthetic since the age of 40 against how often it appeared in people who had not. They did not find a link.

Will A General Anaesthetic Increase My Risk Of Developing Dementia

Whilst there is a known short-term effect of anaesthesia on memory , studies that have investigated a link between dementia risk and general anaesthetics have found mixed results.

These inconsistent findings make it difficult to definitively say whether or not general anaesthesia increases risk of dementia.

Causes Of Memory Loss

Here are some of the more common things that can cause memory loss:

Medications. A number of prescription and over-the-counter medications can interfere with or cause loss of memory. Possible culprits include: antidepressants, antihistamines, anti-anxiety medications, muscle relaxants, tranquilizers, sleeping pills, and pain medications given after surgery.

Alcohol, tobacco, or drug use. Excessive alcohol use has long been recognized as a cause of memory loss.

Smoking harms memory by reducing the amount of oxygen that gets to the brain. Studies have shown that people who smoke find it more difficult to put faces with names than do nonsmokers. Illegal drugs can change chemicals in the brain that can make it hard to recall memories.

Sleep deprivation. Both quantity and quality of sleep are important to memory. Getting too little sleep or waking frequently in the night can lead to fatigue, which interferes with the ability to consolidate and retrieve information.

Depression and stress. Being depressed can make it difficult to pay attention and focus, which can affect memory. Stress and anxiety can also get in the way of concentration. When you are tense and your mind is overstimulated or distracted, your ability to remember can suffer. Stress caused by an emotional trauma can also lead to memory loss.

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Why Arent We Sure Yet

Dementia doesnt occur in amatter of days. It happens over the years.The symptoms show up slowly and often spontaneously. The reason there are somany contradictory or confusing studies regarding this matter is that it may require years of observation. It is notcompletely possible to conduct a study for such a long period, especially when the subjects are above the age of 60.

Most studies conducted on thistopic involved animals such as mice. The studies included highly invasive testprocedures that may be too risky on human subjects. It is why most studies thatinvolve people are usually based on observation rather than tests andexperimentation.

Two of the most widely acknowledge research on this topic revealed completely contradictory conclusions. One followed more than 130,000 elderly who went through surgery within the past 7 years. It concluded that anesthesia could cause long-term changes in older brains that arent too resistive to its effects. This research found general anesthetics to be a contributing factor in dementia.

On the other hand, there was a study that involved more than 8000 pair of twins. The results were completely opposite, and no connection between anesthetics and dementia was found. The researcher concluded that the decline in cognitive abilities of the patients had less to do with the surgery and anesthesia, and more to do with the condition that called for surgery in the first place.

Postoperative Delirium In Seniors: Recognizing The Symptoms Reducing The Risks

General anaesthetic can trigger condition linked to ...

    Immediately after surgery that requires anesthesia, it is normal for older patients to feel somewhat sleepy or a little out of sorts. But when patients experience marked changes in mental function such as confusion, disorientation, persistent sleepiness, hallucinations, agitation, or aggression they might be experiencing post-operative delirium.

    Post-operative delirium is the most common complication of surgery for older adults, according to the American Geriatric Society, affecting up to 50% of seniors. If not identified early and treated, post-operative delirium can lead to long-term health issues, including cognitive decline and functional decline. Patients are also at increased risk of physical injury, hospitalization, and transfer to long-term care facilities.

    Symptoms can appear within hours to weeks after surgery. Unfortunately, post-operative delirium symptoms are often mistaken as signs of dementia, which is an umbrella term for irreversible conditions that cause memory loss and decreased cognitive function. While some symptoms are similar, delirium is not the same as dementia and can be prevented in approximately 40% of cases.

    UT Southwestern has implemented two innovative programs to better identify patients at risk for delirium and support healthier recovery. In these programs, we help caregivers prevent and identify delirium symptoms and help patients maintain their independence after diagnosis through comforting care and rehabilitation.

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    What Are Risk Factors For Post

    The biggest predictor of post-operative delirium, which occurs prior to dementia, is when a patient already suffers from pre-existing dementia. Aside from pre-existing dementia, other pre-operative risk factors include older age , functional impairment and the presence of at least two morbid conditions .

    Additionally, patients who are most susceptible to post-op cognitive decline are the least physically fit, are heavy smokers or have obesity, hypertension, diabetes, arthritis or peripheral vascular disease. For unknown reasons, a stint in the hospital, with or without surgery, is a risk factor for cognitive impairment.

    Im Having Memory Problems After Anesthetic And Surgery Is That Common

    This article was published more than 3 years ago. Some information in it may no longer be current.

    The question: I recently had knee-replacement surgery, and I just dont feel like myself. Im a retired school principal and I used to have an excellent memory. Now I struggle to remember the simplest things even my husbands name. I am slowly getting better, but it has been very frustrating and frightening. My doctor said I could be suffering a side effect from the anesthetic or the operation. Is this a common problem after surgery?

    The answer: Doctors have long assumed that patients return to normal once an anesthetic wears off. But in recent years, a growing body of research suggests that some people experience lingering cognitive impairment after being wheeled out of the operating room.

    We now know that between 10 and 20 per cent of patients will have problems at the time they are discharged from hospital, says Dr. Beverley Orser, an anesthesiologist at Sunnybrook Health Sciences Centre in Toronto.

    And one in 10 of those affected will still have problems three to six months later. What happens at the one-year mark is still debated, she says, adding that some may never fully recover.

    The cognitive impairment seems to affect memory, word-finding and attention as well as certain executive functions of the brain, such as decision-making and problem-solving.

    So what are patients and health-care providers supposed to do while researchers probe for solutions?

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    The Known Effects Of Anesthesia On Brain Cell

    The frailty factor is unignorably real, but it doesnt completely rule out anesthesia as the reason behind memory loss or its connection to degenerative diseases such as Alzheimers.

    General anesthesia used during most surgical procedures can increase the level of toxic clumps on amyloid and tau proteins. These toxins inside the brain cell are indicative of Alzheimers disease. They can cause severe damage to the brain cells over time.

    Anesthesia can also prevent braincells from sending signals to the repair cell. This is one of the most importantsteps of cell repair and regenerationafter surgery. Due to the inability tosend signals, the repair is delayed to the point where inflammation gets worse.Prolonged damage can have long term and short-term impact on the patientscognitive ability.

    Another study revealed that connection between anesthesia and dementia is more profound among patients with an increased genetic risk. It may not necessarily trigger dementia on its own, but it can bring the underlying symptoms to the surface. Since it lowers the body temperature and levels of oxygen in the blood, it can speed up cell degeneration in such patients.

    It’s Easy To Get The Care You Need

    Anesthesia, Cognition and the Elderly Patient

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    Feeling loopy or out of it for a couple of days after surgery is super common and generally resolves pretty quickly, says Richard Anderson, MD, a Premier Health anesthesiologist and medical director of perioperative services at Miami Valley Hospital South.;Postoperative delirium is the formal name for this post-surgery fog.

    But another condition, postoperative cognitive dysfunction or decline , can have more lasting effects on memory, attention, and concentration from months to a lifetime. First described about a century ago, POCD has relatively recently become the subject of more intense medical study, Dr. Anderson says.

    Theres never been an agreed-upon diagnostic criteria for POCD, and its not routinely screened for, he explains. But thats changing.

    Why? First, people over age 60 are two times more likely to encounter POCD than younger surgery patients.

    We have such an aging population now, that the proportion of patients who experience POCD, or are at risk for it, is just going to skyrocket over the next decade.

    Dr. Anderson adds, Patients are very interested in POCD now. The more educated patients get and the more they read about it in the popular media, they are starting to ask about it.

    • How are we going to screen patients before surgery?
    • Who is at risk?
    • What are we going to do about it in terms of anesthesia technique?
    • And how do we follow patients after surgery?

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    The Effects Of Anesthetic Agents On Pocd

    Several studies have also been designed to assess whether the risk of POCD differs with general anesthesia using inhalational agents, vs. GA with TIVA . A recent meta-analysis combined data from seven studies, and concluded that TIVA may reduce the risk of POCD, with an odds ratio of 0.52; however, this certainty of this conclusion is low due to heterogeneity of diagnostic tools utilized, variability in time of assessment, and inconsistent data reporting . Furthermore, the authors reported that there were 11 ongoing studies on the topic at the time of the meta-analysis in 2018. At this time, it would be premature to conclude superiority of one mode of anesthetic.

    Limited available data also demonstrates mixed results regarding the impact of other modifiable factors on POCD risk including hypothermia and pre-operative and intraoperative glycemic control . Further prospective RCT evidence is required to evaluate the contribution of these factors to delayed neurocognitive recovery.

    Consent: Individuals over the age of 65 should be informed of the risk of postoperative delirium and perioperative neurocognitive disorder prior to their procedure;

    Baseline cognitive assessment: Cognitive function should be assessed preoperatively using a brief screening tool. Examples of screening tools provided included the Minicog, MoCA, MMSE, clock-drawing test, verbal fluency test, or the cognitive disorder examination;

    Cognitive Impairment After Anesthesia And Surgery

    Cognitive impairment after anesthesia and surgery is a recognized clinical occurrence.;In the majority of cases, POCD is short-lived and does not cause long-lasting side effects. However, this is not always the case with older adults. Age is one of the determining factors in how long and how severe POCD can be.

    POCD is defined as a new cognitive impairment arising after a surgical procedure. It is a serious condition that can lead to long-term memory loss. Its diagnosis requires both pre-;and postoperative testing.;There is still much research to be completed, but it has been determined that certain conditions, such as heart disease, lung disease, Alzheimers, Parkinsons and having had a previous stroke all increase the elder patients risk for POCD.

    Senior patients considering surgery with general anesthesia should be sure to have an in-depth discussion with their physician and their anesthesiologist about any conditions that might put them at increased risk for incurring POCD. It is also advisable that a loved one or patient advocate attend the pre-surgery meeting with the senior to offer additional information as well as to clearly hear all of the risks. Sharing valuable information, , both from patient to physician and vice versa will definitely contribute to the likelihood of a positive outcome.

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    Immunohistochemistry And Image Analysis

    Mice were sacrificed one hour after the last anesthesia session by intracardiac perfusion with 4% paraformaldehyde. The brains were post-fixed at 4;°C and 50;µm-thick sequential coronal sections were taken from the beginning to the end of the dorsal hippocampus using a Leica VT1200S vibratome. Three sequential hippocampal sections, 200;µm apart, from both dorsal hippocampi per mouse were used for immunohistochemistry.

    Sections were washed three times for 5 mins with 0.3% Triton X-100 in PBS, in a shaker. Sections were permeabilized and blocked with 10% goat serum in PBS Triton-X 0.2% for 1;h, then, incubated with the primary CC3 antibody at 4;°C overnight, washed three times in PBS and incubated with the secondary antibody for one hour. Sections were washed once with PBST, then PBS alone, and lastly with PBS and DAPI at a 1:5000 dilution in PBS.

    The sections were mounted on microscope coverslips using Invitrogen ProLong Gold antifade reagent and images were acquired with a Zeiss epi-fluorescence microscope equipped with Apotome using a 20×objective. The number of CC3-positive cells per section was counted and averaged between both dorsal hippocampi . Three sections per mouse were analyzed for CC3-positive cells by a researcher blinded to the experimental condition or genotype, and the sum of CC3-positive cells in three sections was calculated and presented. Image processing was performed with ImageJ .

    What Is Postoperative Cognitive Dysfunction

    Can Surgery Cause Memory Loss

    After surgery, susceptible older patients may exhibit signs of a type of acute brain failure, which may be temporary or fluctuate. A small number of post-surgery geriatric patients experience mild cognitive impairment for a few months before recoveringwhile some suffer permanent impairment.

    Memory takes a hit, with patients describing their post-surgical mental state as foggy. These elderly individuals also discover their once-competent planning and decision-making skills have deteriorated. Full-blown dementia may result in a small subset of patients who experience delirium after surgery.

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    Anesthesia In Individuals With Cognitive Impairment

    Alzheimers disease accounts for the majority of cases of dementia . AD is a fatal progressive neurodegenerative disorder, characterized by neuronal degeneration in the basal forebrain, entorhinal cortex, hippocampus, and cortex . Pathological hallmarks include the presence of senile plaques which contain Amyloid- , and neurofibrillary tangles which form in the presence of pathological modifications to the microtubule-associated protein, tau. The pathways underlying neurodegeneration are complex and involve many players including soluble and insoluble A, hyperphosphorylated tau, neuroinflammation and microglia dysfunction, cholinergic deficits, and oxidative stress .

    AD and other forms of dementia can impact the ability of anesthesiologists to collect a detailed history and elicit appropriate cooperation for physical examination. The potential for confusion and limited cooperation may make approaches such as neuraxial anesthesia, peripheral nerve blocks, or sedation more challenging. In terms of pharmacologic management, it is commonly accepted that short-acting medications should be used, and medications which may increase risk of postoperative confusion should be avoided . Available evidence does not support the hypothesis that these patients are more sensitive to anesthetic agents; however, the sample size employed in these studies and use of the BIS monitor as a surrogate of anesthetic depth make it challenging to draw any definitive conclusion .

    What Are The Effects Of Anesthesia On The Brain

    Whether or not medical research can pinpoint a direct link between general anesthesia and the subsequent risk for memory issues, one fact is clear: Anesthesia drugs travel into the brain and lodge it into a state of amnesia; loss of consciousness, immobility and decreased blood flow to the brain result.

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    Activation Of Mtorc1 Prevents Apoptosis In The Brain

    We administered intranasal insulin to juvenile mice daily for 7;days prior to repeated exposure to general anesthesia . Notably, the beneficial effects of central insulin persisted after the treatment was discontinued, indicating that insulin triggers long-lasting processes in the brain, which are protective against anesthesia-induced neurotoxicity. Since the effect of intranasal insulin on anesthesia-induced apoptosis is mediated by mTORC1, which regulates mRNA translation, it is conceivable that mTORC1-dependent changes in expression of specific proteins contribute to the long-lasting neuroprotection. Indeed, it has been shown that mTORC1 preferentially promotes translation of nucleus-encoded mitochondria-related mRNAs, enhancing mitochondrial activity and biogenesis,.

    Previous studies have shown that mitochondrial dysfunction plays important roles in anesthesia-induced neurotoxicity,,. General anesthetics increase the activity of mitochondrial complex IV and decrease the activity of superoxide dismutase in mitochondria, resulting in an excessive production of reactive oxygen species ,, mitochondrial fragmentation and cytochrome c release from mitochondria into the cytosol, which subsequently cause caspases-3 activation and apoptosis. Accordingly, reducing ROS or enhancing mitochondrial functions,, is sufficient to prevent anesthesia-induced neurotoxicity and behavioral deficits.

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