Long-term post-operative cognitive decline in the elderly: the effects of anesthesia type, apolipoprotein E genotype, and clinical antecedents.

Abstract : Cognitive dysfunction in the elderly commonly observed following anesthesia has been attributed to age-related neuronal changes exacerbated by pharmacotoxic effects. However, the extent to which these changes may persist following recovery from surgery is still largely unknown. This study investigates the long-term effects of anesthesia on cognitive functioning after orthopedic surgery in 270 elderly patients over the age of 65 who completed a computerized cognitive battery before and 8 days, 4 and 13 months after surgery. Their performance was compared to those of 310 elderly controls who completed the same neuropsychiatric evaluation at baseline and one-year interval. Multivariate analyses adjusted for socio-demographic variables, depressive symptomatology, vascular pathology as well as baseline cognitive performance. We found early and transient post-operative decline in reaction time and constructional praxis. With regard to long-term changes we observed improvement compared to controls in most verbal tasks (probably due to learning effects). On the other hand, a clear dissociation effect was observed for several areas of visuospatial functioning which persisted up to the 13-month follow-up. This specific pattern of visuospatial deficit was found to be independent of apolipoprotein E genotype and closely resembles what has recently been termed vascular mild cognitive impairment, in turn associated with subtle sub-cortical vascular changes. The observation of only minor differences between persons operated by general and regional anesthesia makes it difficult to attribute these changes directly to the anesthetic agents themselves, suggesting that cognitive dysfunction may be attributable at least in part to peri-operative conditions, notably stress and glucocorticoid exposure.
Liste complète des métadonnées

Littérature citée [45 références]  Voir  Masquer  Télécharger

http://www.hal.inserm.fr/inserm-00524226
Contributeur : Dominique Villebrun <>
Soumis le : jeudi 7 octobre 2010 - 12:33:32
Dernière modification le : mardi 31 octobre 2017 - 10:20:04
Document(s) archivé(s) le : lundi 10 janvier 2011 - 11:25:32

Fichiers

Ancelin_J_Alz_Dis_2010.pdf
Fichiers produits par l'(les) auteur(s)

Identifiants

Collections

Citation

Marie-Laure Ancelin, Guilhem De Roquefeuil, Jacqueline Scali, François Bonnel, Jean-François Adam, et al.. Long-term post-operative cognitive decline in the elderly: the effects of anesthesia type, apolipoprotein E genotype, and clinical antecedents.. Journal of Alzheimer's Disease, IOS Press, 2010, 22 Suppl 3, pp.105-13. 〈10.3233/JAD-2010-100807〉. 〈inserm-00524226〉

Partager

Métriques

Consultations de la notice

184

Téléchargements de fichiers

539