Anesthesia & Dementia

AIRAH BARRON
INDEPENDENT STUDY MENTORSHIP- SPRING SEMESTER 2018
Charvat, Mylea. “5 Facts You Need to Know About Dementia.” Psychology Today, Sussex Publishers, 7 Dec.
2017, www.psychologytoday.com/blog/the-fifth-vital-sign/201712/5-facts-you-need-know-about-dementia.
MRS. CLICK
u Disclaimer: Some of this information will be from outside sources.
 Beth Stratton

Ø Certified Registered Nurse Anesthetist

Ø BSN & MSNA
Ø Employed at Clear Lake Regional Hospital
Clear Lake Regional Hospital
u Located on Medical Center Blvd
u Operating rooms feature advances in technology such as the
Da Vinci Surgical System
u Family and friends are able to track loved ones as they
progress from pre-op to recovery
u Surgeons utilize minimal invasive surgical techniques including
laparoscopy and robotics

“Clear Lake Regional Hospital.” Clear Lake Regional Medical Center, clearlakermc.com/.
 ISM & Course Requirements

u The Independent Student Mentorship class is a rigorous academic course

where students are able to mentor with a professional in a chosen career.
u Students enrolled in the course are required to complete an in depth study
of a career of their liking.
u They must attend their mentorship site and document a minimum of 3 hours
a week.
u With the information gathered during the mentorship sessions, students must
complete an online portfolio showcasing assignments done, as well as a
journal entry documenting their mentorship experiences.
u The end result of the course will consist of a mid-term presentation, and a
well developed final product and presentation.

“Clear Springs High School.” Go to Clear Springs High School, clearsprings.ccisd.net/.

https://airahbarronismspring.weebly.com
 Project Topic:
Why Anesthesia & Dementia?
u My project will consist of researching the functions, effects,
and determinants anesthesia has on dementia. It will be
based on on age, cognitive parts of the brain, and
anesthetics.
u my mentor played a big role in the decision after
describing the mystery that still exists today between these
two variables.
u I hope with the help of my mentor and staff we will bring a
resolution to a condition which affects thousands of
people yearly.
“What Causes Dementia?” BrightFocus Foundation, 4 Oct. 2017,
www.brightfocus.org/alzheimers/article/what-causes-dementia.
 Anesthesia

“Westlake Anesthesia – WAG Anesthesia Services.” Westlake Anesthesia,

westlakeanesthesia.com/.
 History of Anesthesia

u Early anesthetics were soporifics- which dull the senses/ induce sleep;
or narcotics
u mid 1840s- only two anesthetic agents regularly used were opium and
alcohol
u Addiction and no complete pain relief
u 1846- Dr. Morton removed tumor from jaw
u Usedsponge soaked in Ether and patient claimed to be
unconscious throughout operation
u First successful surgical procedure with anesthesia
 Properties of anesthesia and Dementia

u During the research and analysis conducted there was no evident correlation between anesthesia
and dementia
u Alzheimer’s or dementia have statistics of affecting 13% of adults who are 65 years or older
u Short term memory loss has been prevalent post-surgery with patients, with patients forgetting over a
couple of days at a time
u Short term memory loss after surgery is known as POCD
u Inhalational anesthetics have recently been presumed to be the source of POCD however this is still
relatively vague
u Inhalational anesthetics have shown an increase in catalysts for POCD and/or dementia
u The few tests that have occurred has proven no linkage with anesthesia and dementia under a 2-year
span
u There has yet to be a randomized and controlled trial for finding a linkage between dementia and
POCD
u Although reviews have been released, there is limited evidence for any conclusions
u Sometimes patients will self-diagnose with dementia when in reality other cognitive changes can
occur such as delirium as based from POCD
u Delirium is said to be a cognitive disturbance or blockage which can occur after the patient has
woken up and can last for several days
u POCD can reappear randomly after a surgery and can in some cases last as long as 5 years
u The cognitive changes shown with POCD aren’t strong enough to hypothesize a linkage with
dementia
u Delirium is a short and revocable lack of attentiveness and perception which affects a large
scope of the older patient population
u For patients already diagnosed as having dementia there is a higher risk for developing delirium
How it works

u Local anesthetics block the nerves that connect a particular body

part or region to the brain, preventing the nerves from carrying pain
signals to your brain.
u Examples include novocaine shots, which dentists use to numb the
nerves in your mouth during a root canal, and epidurals, which
allow for a (relatively) painless childbirth by blocking the nerves that
originate at the base of the spinal cord and serve the pelvic region.
u For serious surgeries that require a patient to be completely
unaware, doctors turn to general anesthesia.
u This renders patients unconscious with no perception or memory
of the surgery (though pain from the surgical procedure will be
apparent once you wake up).
u It also limits the physiological responses to surgical cuts, keeping
blood pressure, stress hormone release and heart rate constant
during the procedure.
u Today, the most common modern general anesthetics are mixtures
of inhalable gases, which include nitrous oxide (laughing gas) and
various derivatives of ether, such as Isoflurane, Sevoflurane, and
desflurane.
u Skilled anesthesiologists administer the drugs via machines that
measure the specific amount necessary to keep the patient out for
the surgery, but not forever.
u Additionally, because the drugs interfere with breathing, patients
are often intubated — meaning a plastic or rubber tube is inserted
in the trachea to keep the airway open — and kept on a
mechanical ventilator.
Dementia

DeMarco, Bob. “4 Memory Systems of the Brain and Dementia.” Alzheimer Reading Room, 27 Feb. 2017,
www.alzheimersreadingroom.com/2014/01/how-dementia-affects-memory-systems-of.html.
History

u Dates back to 2000 BC

u 1797- given name, “out of one’s mind”
u During the 18th century, dementia was a term used for
people with intellectual deficit, acquired at any age.
u No one doctor discovered dementia
u Alzheimer's is one type of dementia discovered in 1906
How it works

u Dementia has to do with damage to brain cells

u When brain cells are damaged it interferes with the
way the body communicates with each other
u Negative effect on judgement, emotions,
behaviors, feelings, actions
 Causes

u Ancestry
u Alcoholism

u Drug use
u Brain injury
u Thyroid function abnormalities
u Alzheimer’s disease
u It’s
not a normal part of aging and can happen at
any point in time
 Two Types of Dementia:

u Alzheimer's disease
u Damaged tissue builds up on the brain due to protein deposits (Plaques)
u Cause cells around them to die
u Chemicals that transfer messages in the brain become affected

u Vascular Dementia
u Arteries supplying blood to the brain tissues become blocked
u Disruption of blood oxygen supply and nutrients lead to strokes in parts of the brain

u Many people with Dementia have a combination of both types

Symptoms

u Cognitive problems
u Harder to understand, think, remember, learn, make judgements
u Functional problems
u As time progresses, it becomes harder to do simple tasks
u Emotional problems
u Control of emotions is harder to manage.
u People ”retreat” from usual activities
Treatments

u Unfortunately Dementia is not one disease which has no cure

yet
u There is no known medicine to slow its progression
u Medicine is mainly used to relax patients with extreme anxiety
 Anesthesia & it’s Effects on the Brain

u Parts of the brain affected

u Long term effects vs short term effects
u How it links to dementia or cognitive aspects

staff, Science X. “Brain Encodes Time and Place of Taste Memory.” Medical Xpress -
Medical Research Advances and Health News, Medical Xpress, 23 Sept. 2014,
medicalxpress.com/news/2014-09-brain-encodes-memory.html.
Dementia & Cognitive Aspects

u An 81-year-old woman who underwent spinal surgery under general anesthesia

began hallucinating the night after her operation
u The nightmare she experienced was defined as an indicator of post-surgery delirium
u Post-surgery delirium is defined as experiencing memory loss and as well as
confusion after undergoing surgery
u The delirium is expected to disappear after a couple of days, however there have
been instances where people have had long term effects
u Even when doctors are aware of the delirium and confusing which can be seen
post-surgery, they have hypothesized inhalational anesthetics are not the source for
the development of dementia
u There are other factors doctors are interested in more such as the health of patient
as well as stress and anxiety
 Anesthesia and the Brain

u Local anesthesia is considered the most common and mild which can numb a small area for a
small procedure
u Regional anesthesia helps block nerve signals to the brain for a large area of the body through
an injection in the spine
u Propofol plays a key role as a tranquillizing agent by modifying brain activity and making the
patient less conscious
u General anesthesia is most commonly used during surgeries and it makes patients completely
unconscious and induces them into a state of amnesia
u The drugs and narcotics are proven to be effective by binding to the proteins of neurons which
regulate cognitive aspects such as learning, sleep, and remembering
u Recent studies have shown no correlation between a specific anesthetic and a downfall for
dementia
Linkage?

u Researchers and doctors hypothesize factors such as age and

being predisposed to certain mental health deficits can be
significant catalyst for dementia after surgery
u Researchers believe the greater the amount of anesthesia and
time spent under the influence, the greater the risk for
developing dementia
Age & Anesthesia

u How age relates to the amount of anesthetics

u Factors to consider according to age
u What is at risk- health, diseases, surgery

Allan. “Children Undergoing General Anesthesia Archives – St. Lawrence.” Dental Office in
Mississauga, 29 Aug. 2017, www.stlawrencedentistry.com/2014/11/29/children-undergoing-
general-anesthesia-or-deep-sedation/.
 Age & Anesthetics

u The doses required to achieve the same anesthetic state in older patients can be as little as half
what is needed for younger patients.
u Explanations for that difference have focused on age-related declines in cardiovascular,
respiratory, liver and kidney function
u the primary sites of anesthetic effects are the brain and central nervous system

u We know even less about how anesthetic drugs influence brain activity in children, and the
current standard of care for assessing the brain state of children under anesthesia calls only for
monitoring vital signs like heart rate and blood pressure
u This lack of knowledge is especially troubling, given recent studies suggesting an association
between early childhood surgery requiring general anesthesia and later cognitive problems.
 Surgery and Age

u 1 in 10 people who have surgery are 65 or older.

u One concern for older patients is that the aging brain is more
vulnerable to anesthesia, medication that prevents you from feeling
pain during surgery often by sedating you or making you lose
consciousness
u anesthesia-related surgery risks that are more common in older people:
u Postoperative delirium & Postoperative cognitive dysfunction (POCD)
Postoperative delirium

u Postoperative delirium
u This is a temporary condition that causes the patient to be
confused, disoriented and unaware of surroundings, and
have problems with memory and paying attention. It may
not start until a few days after surgery, may come and go,
and usually disappears after about a week.
 Postoperative cognitive
dysfunction (POCD)
u This is a more serious condition that can lead to long-term memory loss and make
it difficult to learn, concentrate and think.
u Because some of these problems are already common in elderly people, the
only way to determine if a patient actually has POCD is to conduct a mental
test before surgery.
u Certain conditions, including heart disease (especially congestive heart
failure), lung disease, Alzheimer’s disease, Parkinson’s disease and having
had a stroke in the past, increase your risk for POCD.
u Researchers in anesthesia care continue to study and learn more about
these conditions and how to prevent or reduce the effects.
 Risk Reduction in Older Patients

u Ask your physician to conduct a pre-surgery cognitive test — an assessment of your

mental function. The physician can use the results as a baseline for comparison
after surgery.
u Be sure your caregiver or person who spends the most time with you stays with you
as you recover, carefully observes your physical and mental activity after surgery
and reports anything troubling to your physician.
u Check with your physician before taking medications after surgery that can affect
your nervous system, such as those for anxiety, seizures, muscle spasms and
difficulty falling asleep.
 Age & Dementia

u How age relates to Dementia or cognitive

deterioration
u Factors to consider according to age- dosage, type
of anesthetic
u What is at risk- health DailyCaring. “What's the Difference Between Alzheimer's and
Dementia?” DailyCaring, 5 June 2017, dailycaring.com/alzheimers-and-
dementia-know-the-difference/.
Dementia Development

u Although age plays a large factor in developing dementia there

are also numerous health and genetic factors involved
u Someone with a family member who has dementia could be a
carrier of the gene if the mutation is present in their DNA
u People who are carrier for the gene could be carrying gene known
as a APOE4 which puts them at 3 times greater risk of developing
dementia
u Studies suggest the amount of grey matter might have a
correlation with carriers of APOE4, the lesser the amount the
greater the risk
Risks

u The greatest known risk factor for Alzheimer’s is increasing age.

Most individuals with the disease are 65 and older. One in nine
people in this age group and nearly one-third of people age 85
and older have Alzheimer’s.

u Another strong risk factor is family history. Those who have a

parent, brother or sister with Alzheimer’s are more likely to develop
the disease.
 Current Event

u This article pertains to anesthesia and the unforeseen

outcomes in the brain that come as a result of its mysterious
properties.
u In most cases, anesthesia has proven it does not increase
the chances of developing dementia, but rather increase
the buildup of the proteins that appear to have a
correlation with Alzheimer’s.
“Operating Room.” Operating & Surgery Room | St. Mary's Health System |
Maine, www.stmarysmaine.com/departments-services/surgical-
u In this manner, researchers speculate neuroinflamation
services/operating-room.
from surgery instead of inhalational anesthetics is the
source of cerebral degeneration.
 Post-surgery delirium is
defined as experiencing
memory loss and as well as
confusion after undergoing
surgery

CRNA of the Year!

Beth Stratton

Anesthesia!
proven to be effective by
People who are carrier for the gene
binding to the proteins of

Product
could be carrying gene known as a
neurons
APOE4 which puts them at 3 times
greater risk of developing
“Researchers and doctors dementia!!!
hypothesize factors such as age
and being predisposed to certain
mental health deficits can be
An 81-year-old woman who
significant catalyst for dementia
after surgery underwent spinal surgery under
The greater the amount of
general anesthesia began
anesthesia and time spent under
hallucinating the night after her
the influence, the greater the risk
for developing dementia” operation!!!
Pg.12
From research, it was
concluded African
ALZHEIMERS DISEASE : Americans and Hispanics
are two of the most
Damaged tissue builds up on the brain prone races to develop
dementia
due to protein deposits (Plaques)

Pg. 10
Inhalational anesthetics have recently been presumed to be the source of POCD
Artifacts
Anesthesia: loss of sensation with or without loss of consciousness

Propofol: is a short-acting medication that results in a decreased

level of consciousness and lack of memory for events. Its uses
include the starting and maintenance of general anesthesia,
sedation for mechanically ventilated adults, and procedural
sedation.

Dementia: It's an overall term that describes a group of

symptoms associated with a decline in memory or other thinking skills
severe enough to reduce a person's ability to perform everyday
activities.
Conclusion

u To date, there have not been randomized

controlled trials to provide evidence for such a
causal relationship
u meta-analysis of 15 case–control studies
revealed no statistically significant association
between general anesthesia and the
development of AD
u However there is still a lot of ground to cover
pertaining this topic
Thank You.

u I would like to thank my mentor, Mrs. Stratton

for her dedication in her field of anesthesia,
as well as Mrs. Click and the evaluators for
their time.
 Works Cited
u Allan. “Children Undergoing General Anesthesia Archives – St. Lawrence.” Dental Office in Mississauga, 29 Aug. 2017,

www.stlawrencedentistry.com/2014/11/29/children-undergoing-general-anesthesia-or-deep-sedation/.

u Charvat, Mylea. “5 Facts You Need to Know About Dementia.” Psychology Today, Sussex Publishers, 7 Dec. 2017,

www.psychologytoday.com/blog/the-fifth-vital-sign/201712/5-facts-you-need-know-about-dementia.

u “Clear Lake Regional Hospital.” Clear Lake Regional Medical Center, clearlakermc.com/.

u “Clear Springs High School.” Go to Clear Springs High School, clearsprings.ccisd.net/.

u DailyCaring. “What's the Difference Between Alzheimer's and Dementia?” DailyCaring, 5 June 2017,

dailycaring.com/alzheimers-and-dementia-know-the-difference/.

u DeMarco, Bob. “4 Memory Systems of the Brain and Dementia.” Alzheimer Reading Room, 27 Feb. 2017,

www.alzheimersreadingroom.com/2014/01/how-dementia-affects-memory-systems-of.html.
 Works Cited

u “Hospital to Replace Doctors with Parents Who Have Done Their Research.” The Science Post, 10 Feb. 2017,

thesciencepost.com/hospital-to-replace-doctors-with-parents-who-have-done-their-research/.

u “Operating Room.” Operating & Surgery Room | St. Mary's Health System | Maine,

www.stmarysmaine.com/departments-services/surgical-services/operating-room.

u Staff, Science X. “Brain Encodes Time and Place of Taste Memory.” Medical Xpress - Medical Research Advances and Health News, Medical Xpress, 23 Sept. 2014,

medicalxpress.com/news/2014-09-brain-encodes-memory.html.

u “Westlake Anesthesia – WAG Anesthesia Services.” Westlake Anesthesia, westlakeanesthesia.com/.

u “What Causes Dementia?” BrightFocus Foundation, 4 Oct. 2017,

www.brightfocus.org/alzheimers/article/what-causes-dementia.