Can Surgery Anesthesia Cause Dementia In Seniors Posted On: 07
Learn about the potential senior cognitive decline after surgery.
For seniors, experiencing surgery always includes some inherent risks, but theres a little-known effect impacting a significant number of seniors following surgery that people all need to be aware of: POCD . POCD takes place in more than 25% of seniors during the days after non-cardiac surgery, and can present with a variety of symptoms, some that can easily be almost indiscernible: forgetfulness, loss in concentration and focus, along with other types of cognitive decline that impact quality of life.
Research points towards the medical procedure itself together with associated stress, rather than anesthesia, as the culprit in POCD. Per Dr. Roderic Eckenhoff, vice chair for research and Perelman School of Medicine at the University of Pennsylvania professor of anesthesiology, Most surgery causes peripheral inflammation. In young people, the brain remains largely isolated from that inflammation, but with older people, our blood-brain barrier becomes kind of leaky. That contributes to neuroinflammation, which activates a whole cascade of events in the brain that can accelerate the ongoing aging process.
What Other Things Help
In addition to medications, there are various ways to help a person with vascular dementia. Research has shown that physical exercise and maintaining a healthy weight help to enhance brain health and reduce the risk of heart problems, stroke and other diseases that affect blood vessels. A balanced diet, enough sleep and limited alcohol intake are other important ways to promote good brain health and reduce the risk for heart disease. Other illnesses that affect the brain, such as diabetes, high blood pressure and high cholesterol, should also be treated if present.
What Causes A Cerebral Aneurysm
Cerebral aneurysms form when the walls of the arteries in the brain become thin and weaken. Aneurysms typically form at branch points in arteries because these sections are the weakest. Occasionally, cerebral aneurysms may be present from birth, usually resulting from an abnormality in an artery wall.
Risk factors for developing an aneurysm
Sometimes cerebral aneurysms are the result of inherited risk factors, including:
- genetic connective tissue disorders that weaken artery walls
- polycystic kidney disease
- arteriovenous malformations
- history of aneurysm in a first-degree family member .
Other risk factors develop over time and include:
- untreated high blood pressure
- cigarette smoking
- drug abuse, especially cocaine or amphetamines, which raise blood pressure to dangerous levels. Intravenous drug abuse is a cause of infectious mycotic aneurysms.
- age over 40.
Less common risk factors include:
- head trauma
- brain tumor
- infection in the arterial wall .
Additionally, high blood pressure, cigarette smoking, diabetes, and high cholesterol puts one at risk of atherosclerosis , which can increase the risk of developing a fusiform aneurysm.
Risk factors for an aneurysm to rupture
Not all aneurysms will rupture. Aneurysm characteristics such as size, location, and growth during follow-up evaluation may affect the risk that an aneurysm will rupture. In addition, medical conditions may influence aneurysm rupture.
Risk factors include:
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What Is The Usual Damage To The Brain After An Aneurysm Bleeds
Once an aneurysm bleeds, the chance of death is about 40% and the chance of some brain damage is about 66 %, even if the aneurysm is treated. If the aneurysm isnt treated quickly enough, another bleed may occur from the already ruptured aneurysm.
Vasospasm is a common complication following a ruptured aneurysm. This can lead to further brain damage. Other problems may include hydrocephalus , difficulty breathing that requires a mechanical ventilator, and infection.
Why is the damage so extensive after bleeding? After blood enters the brain and the space around it, direct damage to the brain tissue and brain function results. The amount of damage is usually related to the amount of blood. Damage is due to the increased pressure and swelling from bleeding directly into the brain tissue, or from local cellular damage to brain tissue from irritation of blood in the space between the brain and the skull.
Blood can also irritate and damage the normal blood vessels and cause vasospasm . This can interrupt normal blood flow to the healthy brain tissue and can cause even more brain damage. This is called an ischemic stroke.
Will treating a ruptured aneurysm reverse or improve brain damage? Once an aneurysm bleeds and brain damage occurs, treating the aneurysm will not reverse the damage. Treatment helps prevent more bleeding.
Research Into The Cause Of Vascular Dementia
Vascular dementia is the second most commonly diagnosed type of dementia, and may account for 15 – 20% of all cases. Vascular dementia is caused by chronic reduced blood flow to the brain, usually as a result of a stroke or series of strokes. It can often coexist with Alzheimer’s disease.
Stroke, small vessel disease, or a mixture of the two can cause vascular dementia. Most commonly there is a blockage of small blood vessels somewhere in the network of arteries that feeds the brain. Blockages may be caused by plaque build up on the inside of the artery wall, or by blood clots which have broken loose. Clots can form as a result of abnormal heart rhythms, or other heart abnormalities. Also, a weak patch on an artery wall can balloon outward and form an aneurysm, which can burst and deprive brain cells of oxygen.
It is estimated that about 50% of cases of vascular dementia result from high blood pressure, which can lead to a major stroke or a series of strokes and a build up of brain damage over time. Less common causes of vascular dementia are associated with autoimmune inflammatory diseases of the arteries such as lupus and temporal arteritis, which are treatable with drugs that suppress the immune system.
An inherited form of vascular dementia known as CADASIL is caused by a mutation on the Notch3 gene. This is a very rare form of dementia and only affects families carrying the Notch3 gene mutation.
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What Treatments Are Available
- Medical therapy. Small, unruptured aneurysms that arent creating any symptoms may not need treatment unless they grow, trigger symptoms or rupture. Its very important to have annual check-ups to monitor blood pressure, cholesterol and other medical conditions.
- Neurosurgery.Depending on a persons risk factors, open surgery may be recommended. Patients are placed under general anesthesia, and the neurosurgeon places a surgical clip around the base of the aneurysm.
- Neurointerventionalist/neuroradiologist.Depending on the aneurysms size, location and shape, it may be treatable from inside the blood vessel. This minimally invasive procedure is similar to the cerebral angiogram. However, in addition to taking pictures, a catheter is directed through the blood vessels into the aneurysm itself. Then, using X-ray guidance, the endovascular surgeon carefully places soft platinum micro-coils into the aneurysm and detaches them. The coils stay within the aneurysm and act as a mechanical barrier to blood flow, thus sealing it off
What Is The Outlook For Stroke
At this time, there is no known cure for vascular dementia. While treatment can stop or slow the worsening of symptoms, or even improve them in some cases, the damage done to the brain by a stroke cannot be reversed.
As dementia progresses, behavior problems usually become more severe. Troubling behaviors like agitation, aggression, wandering, sleep disorders, and inappropriate sexual behavior may become unmanageable. The physical demands of caregiving, such as bathing, dressing, grooming, feeding, and assisting with using the toilet, may become overwhelming for family members. Under these conditions, the family may decide to place the person in a nursing home or similar facility.
Vascular dementia appears to shorten life expectancy. The most common causes of death are complications of dementia and cardiovascular disease.
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What Are The Complications If You Have A Brain Bleed
When the aneurysm leaks or bursts open, blood flows into or around the brain. The pooling blood irritates brain tissue, which can make the brain swell. The result can be permanent brain damage, stroke or other complications such as:
- Vasospasm, when blood vessels get narrower and less oxygen reaches the brain.
- Hydrocephalus, a buildup of spinal fluid around the brain, sometimes called water on the brain, that puts pressure on the brain.
- Coma, when you lose consciousness for several days to weeks.
- Hyponatremia, when the bloods sodium level changes, which can make brain cells swell and cause brain damage.
- Seizures, or muscle convulsions, which can cause further brain damage.
How Are Cerebral Aneurysms Diagnosed
Most cerebral aneurysms go unnoticed until they rupture or are detected during medical imaging tests for another condition.
If you have experienced a severe headache or have any other symptoms related to a ruptured aneurysm your doctor will order tests to determine if blood has leaked into the space between the skull bone and brain.
Several tests are available to diagnose brain aneurysms and determine the best treatment. These include:
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Who Is At Risk Of Developing Dementia After Brain Injury
The incidence of those who develop dementia after a brain injury is estimated to be about two-fold of those in the general population. The risk factors that may make someone more susceptible to dementia include:
- a Hemorrhagic versus Ischemic stroke . This may be linked to the diffuse nature of a bleed, and the possible disruption of the blood-brain-barrier.
- a stroke or brain injury occurring at a younger age regardless of type, people who sustain an injury at a younger age are at an increased risk of developing dementia over the course of their lifespan.
Persons are also at the highest risk of dementia one year post-injury. After the one year mark, the increased risk persists across all types of brain injury/stroke, but at lower levels than before.
What Is The Medical Treatment For Stroke
Drug therapies in vascular dementia include those that prevent clotting and treat underlying vascular risk factors to prevent further progression of dementia. Drug therapies may also treat associated symptoms like depression.
- Antiplatelet agents: These are medications that inhibit blood clotting by altering platelet function and aggregation. Platelet inhibition is a mild form of blood thinning. These agents help prevent recurrent stroke.
- Antihypertensive agents: These drugs reduce blood pressure and thus help prevent strokes.
- Other agents may be given to treat additional risk factors for stroke .
- Antidepressant agents: Severe depression is a very common mood disorder in vascular dementia and may contribute to cognitive decline. Treating the depression with medication may not only relieve the depression but also improve mental functioning.
If you take medications for other medical conditions, your health care provider may adjust or change these medications. Some drugs can worsen dementia symptoms.
Symptoms such as social inappropriateness and aggression may improve with various behavior-changing interventions. Some interventions focus on helping the individual adjust or control his or her behavior. Others focus on helping caregivers and other family members change the person’s behavior. These approaches sometimes work better when combined with drug treatment.
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How Does Vascular Dementia Progress
Vascular dementia usually progresses gradually in a step-wise fashion in which a person’s abilities deteriorate after a stroke, and then stabilise until the next stroke. If further strokes do not occur, the abilities of people with Vascular dementia may not continue to decline, or in some cases, may improve. However, these improvements may not last. Sometimes the steps are so small that the decline appears gradual. On average though, people with Vascular dementia decline more rapidly than people with Alzheimer’s disease. Often they die from a heart attack or major stroke.
Are There Support Groups And Counseling For Stroke
If you have vascular dementia, you know how difficult this can be. It affects every aspect of your life, including family relationships, work, financial status, social life, and physical and mental health. You feel the frustration of being disabled and dependent. You may feel angry, resentful, or hopeless.
Caregivers have similar feelings of frustration. If you are a caregiver, you may feel unable to cope with the demands of caring for a dependent, difficult relative. Besides the sadness of seeing the effects of your loved one’s disease, you may feel overwhelmed, resentful, and angry. These feelings may in turn leave you feeling guilty, ashamed, and anxious. Depression is not uncommon, but it usually gets better with treatment.
Caregivers have different thresholds for tolerating these challenges. For many caregivers, just venting or talking about the frustrations of caregiving can be enormously helpful. Others need more, but may feel uneasy about asking for the help they need. One thing is certain, though: if you, as a caregiver, are given no relief, you can burn out, develop your own mental and physical problems, and become unable to care for the person with dementia.
Support groups meet in person, on the telephone, or on the Internet. To find a support group that works for you, contact the following organizations. You can ask your health care provider, or go on the Internet. If you do not have access to the Internet, go to the public library.
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How Is An Aneurysm Treated
Treatment for aneurysm is difficult due to problems accessing parts of the brain, and may only be considered if the aneurysm is considered to be at risk of rupturing or has ruptured already.
Treatment generally involves surgical clipping, where a section of skull is removed and a clip placed over the neck of the aneurysm to stop blood flowing into it, or coiling, where a series of platinum coils are threaded from the patient’s lower body up into the brain aneurysm, filling it with the platinum and stopping blood flow.
Not all treatments are suitable in all cases, and the medical team will be able to advise on this.
What Are The Symptoms Of Brain Aneurysm
People, in general, do not give much attention to any symptoms until they become severe. This phenomenon also holds water for brain aneurysm cases as well.
Signs and symptoms of brain aneurysm depend on the type of aneurysm and the body constitution of the patient.
Various symptoms related to brain aneurysm are:
Ruptured Brain Aneurysm:
1) Sudden and severe headache2) Nausea4) Stiffness around the neck region5) Blurred vision6) Sensitivity to bright lights7) Seizure
4) Distorted speech pattern and behaviour5) Fainting
1) Pain in the eyes2) Dilated pupil4) Numbness on one side of the face
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Vascular Dementia Vs Alzheimers
Alzheimers disease, like vascular dementia, is a form of dementia. In fact, it is the most common type. Some people use the terms interchangeably. However, Alzheimers is a type of dementia, not dementia itself.
Unlike vascular dementia, Alzheimers disease isnt caused by stroke. There is no known cause of Alzheimers, and your risk of developing it increases with age. The Alzheimers Association estimates that it makes up 80 percent of all dementia diagnoses, which is why the two terms are often confused. Vascular problems, such as stroke, high cholesterol, and hypertension, arent related to Alzheimers disease, as they are with vascular dementia.
While Alzheimers can cause memory issues, some of the first signs are not memory related. Adults in the early stages of the disease might have vision, word finding, and spatial difficulties. It can also cause poor judgement in everyday tasks. This differs a bit with vascular dementia, which usually causes memory problems in the earliest stages.
Although vascular dementia and Alzheimers are not the same disease, it is possible to have both. In fact, according to the Alzheimers Society, about 10 percent of people who have dementia have a form called mixed dementia. Most of these cases include both vascular dementia and Alzheimers disease. A person in this situation could exhibit symptoms of both of these types of dementia.
Several conditions and factors can damage blood vessels. They include:
What Is The Outcome Of Brain Aneurysm
Brain aneurysms are deadly. About 10% of patients with a ruptured aneurysm die before receiving medical care. If untreated, another 50% will die within a month, with a 20% risk of rebleed by the end of the first two weeks. Aside from the bleeding issues, there is significant risk of artery spasm leading to stroke.
Survival rates are increased in patients who present early to the hospital. Early diagnosis, aneursym repair, and control of blood vessel spasms with appropriate medications are all associated with increased survival.
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Risk Of Dementia From A Traumatic Brain Injury
Research has shown that individuals who have suffered repetitive head traumas, such as veterans or sportsmen, may be at higher risk of developing dementia further along the line.
Depending on which part of the brain was damaged, this prolonged exposure to situations in which head injuries may occur can cause common dementia symptoms such as:
- uncoordinated movement
The onset of dementia may happen suddenly, or many years after the trauma happened.
Alzheimers And Vascular Dementia
Unlike AD, VCI often begins with symptoms other than the loss of the ability to recall and reexperience specific episodes from ones past. Researchers have noted that people with VCI often develop more noticeable difficulty with attention, information processing, and executive functioning at the outset of the disease. Memory and language effects vary more. Changes in behavior including depression and apathy are common. Recognition of VCI is complicated by the fact that some standard dementia tests are less able to detect the impairment associated with VCI.
How Is An Aneurysm Diagnosed
Special imaging tests can detect a brain aneurysm. In the CTA , patients are placed on a table that slides into a CT scanner. A special contrast material is injected into a vein, and images are taken of the blood vessels to look for abnormalities such as an aneurysm. In the second test, called MRA , patients are placed on a table that slides into a magnetic resonance scanner, and the blood vessels are imaged to detect a cerebral aneurysm.
The most reliable test is called a diagnostic cerebral angiogram. In this test, the patient lies on an X-ray table. A small tube is inserted through a blood vessel in the leg and guided into each of the blood vessels in the neck that go to the brain. Contrast is then injected, and pictures are taken of all the blood vessels in the brain. This test is slightly more invasive and less comfortable.
Beforeanytreatment is considered, a diagnostic cerebral angiogram is usually performed to fully map a plan for therapy.
If one aneurysm forms, will others form? Having one aneurysm means theres about a 20 % chance of having one or more other aneurysms.