General Anesthesia & ApoE4
Re: General Anesthesia & ApoE4
I would have her seek a second and third opinion on ECT and would want to see a 3/3 agreement on it's need before I would consider proceeding. That is a lot of stress on a 70 year old person. Too many unknowns here.
Re: General Anesthesia & ApoE4
Hi Veero!Veero wrote:I just had my second foot reconstruction surgery a month ago...This time around, I felt very slightly foggy-brained for a couple of weeks but fine now (other than the added stress of preparing for the upcoming hurricane when I can't walk and am in a wheelchair!)....
I hope you have some help preparing for Hurricane Dorian, and that you are in a safe home, or able to get to a shelter. I had my own version of reconstruction in January, with bunion and hammertoe surgery and my foot now has titanium and some long scars. I would not have wanted the added stress of an imminent Category 5 hurricane!
Like you, I asked for a popliteal block, which worked fine, and I found that my brain did also, especially after it stopped receiving so many pain signals. Since this is your second such surgery, you have probably already learned the lesson my PT gave me: Be a patient patient! I also learned that the PT was my best source for tips, exercises and encouragement on how well I was doing, once I could start working with her.
Hugs to you and everyone affected by Dorian! Let us know how you've fared once this is over--and you have power again.
4/4 and still an optimist!
Re: General Anesthesia & ApoE4
With this recent article from Neuroscience News I thought I would add to this thread.
Study Shows the Relationship Between Surgery and Alzheimer’s Disease
From the article:
“Major Surgery Affects Memory in Individuals with Cerebral Amyloid-β Pathology” by Carmen Lage et al. Journal of Alzheimer’s Disease
Study Shows the Relationship Between Surgery and Alzheimer’s Disease
From the article:
A new study published in the Journal of Alzheimer’s Disease carried out by researchers at the Marqués de Valdecilla-IDIVAL University Hospital, in collaboration with researchers at the University of Bonn Medical Center, proposes that major surgery is a promoter or accelerator of Alzheimer’s disease (AD). The first author of the publication was Carmen Lage and the principal investigator Pascual Sánchez-Juan.
Carmen Lage said: “Although the phenomenon of cognitive deterioration after surgery has been known for a long time, there are few studies that relate it to AD. In the clinic, the patient’s relatives frequently tell us that memory problems began after a surgical procedure or a hospital admission. This posed the following question: Is this just a recall bias or has surgery triggered the appearance of the symptoms in a previously affected brain?”
The main result was that half of the patients’ cognition worsened compared to their state before surgery, and those who had altered amyloid-β levels exhibited a pattern compatible with the onset of AD, in which memory problems predominated.
Original Research: Closed access.These results lead us to the conclusion that major surgery can trigger different patterns of cognitive alterations, depending on the previous presence or absence of Alzheimer’s pathological changes.
“Major Surgery Affects Memory in Individuals with Cerebral Amyloid-β Pathology” by Carmen Lage et al. Journal of Alzheimer’s Disease
-Theresa
ApoE 4/4
ApoE 4/4
Re: General Anesthesia & ApoE4
Another just published paper on this subject to add to this thread and perhaps bring to the attention of your surgeon if facing surgery.
Surgery Performed Under Propofol Anesthesia Induces Cognitive Impairment and Amyloid Pathology in ApoE4 Knock-In Mouse Model (Jong-Ho Kim et al, April 26, 2021) https://doi.org/10.3389/fnagi.2021.658860
A mouse study, but final paragraph:
Surgery Performed Under Propofol Anesthesia Induces Cognitive Impairment and Amyloid Pathology in ApoE4 Knock-In Mouse Model (Jong-Ho Kim et al, April 26, 2021) https://doi.org/10.3389/fnagi.2021.658860
A mouse study, but final paragraph:
Propofol anesthesia/surgery caused persistent changes in cognition and pathological changes in the hippocampus of pre-symptomatic but vulnerable AD mice. It would be interesting to explore whether patients with MCI or preclinical AD are at greater risk of POCD. It is difficult to diagnose preclinical AD; however, in patients with risk factors for AD, such as a familial history, genetic predisposition, and/or a history of stroke, diabetes, and/or MCI, clinicians should be careful when planning anesthesia and surgery.
-Theresa
ApoE 4/4
ApoE 4/4
Re: General Anesthesia & ApoE4
Thanks for finding and sharing this, Theresa.TheresaB wrote:Another just published paper on this subject to add to this thread and perhaps bring to the attention of your surgeon if facing surgery.
Surgery Performed Under Propofol Anesthesia Induces Cognitive Impairment and Amyloid Pathology in ApoE4 Knock-In Mouse Model (Jong-Ho Kim et al, April 26, 2021) https://doi.org/10.3389/fnagi.2021.658860
A mouse study, but final paragraph:
Propofol anesthesia/surgery caused persistent changes in cognition and pathological changes in the hippocampus of pre-symptomatic but vulnerable AD mice. It would be interesting to explore whether patients with MCI or preclinical AD are at greater risk of POCD. It is difficult to diagnose preclinical AD; however, in patients with risk factors for AD, such as a familial history, genetic predisposition, and/or a history of stroke, diabetes, and/or MCI, clinicians should be careful when planning anesthesia and surgery.
The use of genetically engineered ApoE4 mice (all male in this case) with amyloid deposits but not yet showing cognitive delays is innovative, and concerning based on the reported results. I did note that while the abdominal surgical procedure only lasted 10 minutes, the mice were under anesthesia for two hours.
I had general anesthesia for a C-Section and was under less than 30 minutes, I believe. Same for more recent surgery to remove a polyp. My husband was under less than an hour for a tricky gallbladder. Of course some surgeries are going to require extensive sedation, but it may be helpful for people to ask about laparoscopic options, epidurals and regional blocks for anything that is not emergency surgery.The total anesthesia duration was up to 2 h... All surgeries were performed by a single operator; each procedure required 10 min.
4/4 and still an optimist!
Re: General Anesthesia & ApoE4
Not ApoE4 specific, but these findings may lead to understanding why anesthesia leads to post-operative issues in some.
The full text of the research paper Blood tau-PT217 contributes to the anesthesia/surgery-induced delirium-like behavior in aged mice is behind a paywall, but this article Alzheimer's disease plasma biomarker contributes to postoperative delirium-like behavior in rodents does a good job in explaining the findings. A quote:
The full text of the research paper Blood tau-PT217 contributes to the anesthesia/surgery-induced delirium-like behavior in aged mice is behind a paywall, but this article Alzheimer's disease plasma biomarker contributes to postoperative delirium-like behavior in rodents does a good job in explaining the findings. A quote:
Additionally, preoperative plasma levels of Tau-PT217 and Tau-PT181 serve as biomarkers of postoperative delirium in older patients. Moreover, plasma levels of Tau-PT217 and Tau-PT181 increase following anesthesia and surgery in patients.
Thus, understanding whether acute postoperative elevations in plasma Tau-PT217 and Tau-PT181 contribute to postoperative delirium may reveal the pathogenesis and facilitate the identification of targeted interventions for this condition.
-Theresa
ApoE 4/4
ApoE 4/4