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Perioperative Considerations for Patients with a Known Diagnosis of Dementia

Published:September 09, 2021DOI:https://doi.org/10.1016/j.aan.2021.07.007
      Dementia is a strong predictor for postoperative complications and greater hospital cost and is an independent predictor of 30-day mortality.

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      References

        • Organization WH
        Dementia.
        (Available at:) (Accessed January 15, 2021)
        • Roberts R.
        • Knopman D.S.
        Classification and epidemiology of MCI.
        Clin Geriatr Med. 2013; 29: 753-772
      1. The Alzheimers Association Report. 2020 Alzheimer's disease facts and figures.
        Alzheimer's Dement. 2020; 16: 391-460
      2. The top 10 causes of death. World Health Organization, 2020 (Available at:) (Accessed January 12, 2021)
        • Culley D.J.
        • Flaherty D.
        • Fahey M.C.
        • et al.
        Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients.
        Anesthesiology. 2017; 127: 765-774
        • Mehaffey J.H.
        • Hawkins R.B.
        • Tracci M.C.
        • et al.
        Preoperative dementia is associated with increased cost and complications after vascular surgery.
        J Vasc Surg. 2018; 68: 1203-1208
        • Evered L.A.
        • Silbert B.S.
        • Scott D.A.
        • et al.
        Preexisting cognitive impairment and mild cognitive impairment in subjects presenting for total hip joint replacement.
        Anesthesiology. 2011; 114: 1297-1304
        • Kumar C.M.
        • Seet E.
        Cataract surgery in dementia patients-time to reconsider anaesthetic options.
        Br J Anaesth. 2016; 117: 421-425
        • Seitz D.P.
        • Gill S.S.
        • Gruneir A.
        • et al.
        Effects of dementia on postoperative outcomes of older adults with hip fractures: a population-based study.
        J Am Med Dir Assoc. 2014; 15: 334-341
        • Steunenberg S.L.
        • Te Slaa A.
        • Ho G.H.
        • et al.
        Dementia in patients suffering from critical limb ischemia.
        Ann Vasc Surg. 2017; 38: 268-273
        • Hanna K.
        • Khan M.
        • Ditillo M.
        • et al.
        Prospective evaluation of preoperative cognitive impairment and postoperative morbidity in geriatric patients undergoing emergency general surgery.
        Am J Surg. 2020; 220: 1064-1070
        • Khan M.A.
        • Hossain F.S.
        • Ahmed I.
        • et al.
        Predictors of early mortality after hip fracture surgery.
        Int Orthop. 2013; 37: 2119-2124
        • Kassahun W.T.
        The effects of pre-existing dementia on surgical outcomes in emergent and nonemergent general surgical procedures: assessing differences in surgical risk with dementia.
        BMC Geriatr. 2018; 18: 153
        • Reitz C.
        • Brayne C.
        • Mayeux R.
        Epidemiology of Alzheimer disease.
        Nat Rev Neurol. 2011; 7: 137-152
        • Ferencz B.
        • Gerritsen L.
        Genetics and underlying pathology of dementia.
        Neuropsychol Rev. 2015; 25: 113-124
        • Loy C.T.
        • Schofield P.R.
        • Turner A.M.
        • et al.
        Genetics of dementia.
        Lancet. 2014; 383: 828-840
        • Rolfson D.B.
        • Majumdar S.R.
        • Tsuyuki R.T.
        • et al.
        Validity and reliability of the Edmonton Frail Scale.
        Age Ageing. 2006; 35: 526-529
        • Church S.
        • Rogers E.
        • Rockwood K.
        • et al.
        A scoping review of the clinical frailty scale.
        BMC Geriatr. 2020; 20: 393
        • Alzheimer's A.
        2016 Alzheimer's disease facts and figures.
        Alzheimers Dement. 2016; 12: 459-509
        • Bunn F.
        • Burn A.M.
        • Goodman C.
        • et al.
        Comorbidity and dementia: a scoping review of the literature.
        BMC Med. 2014; 12: 192
      3. Bunn F, Burn AM, Goodman C, et al. Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem). Southampton (UK): Health services and delivery research; 2016, Vol. 4(8). p. 1-156.

        • Polenick C.A.
        • Min L.
        • Kales H.C.
        Medical comorbidities of dementia: links to caregivers' emotional difficulties and gains.
        J Am Geriatr Soc. 2020; 68: 609-613
        • Curtis M.S.
        • Forman N.A.
        • Donovan A.L.
        • et al.
        Postoperative delirium: why, what, and how to confront it at your institution.
        Curr Opin Anaesthesiol. 2020; 33: 668-673
        • Tisher A.
        • Salardini A.
        A comprehensive update on treatment of dementia.
        Semin Neurol. 2019; 39: 167-178
        • Schneider L.S.
        • Tariot P.N.
        • Dagerman K.S.
        • et al.
        Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease.
        N Engl J Med. 2006; 355: 1525-1538
        • Bains J.
        • Birks J.
        • Dening T.
        Antidepressants for treating depression in dementia.
        Cochrane Database Syst Rev. 2002; (CD003944)
        • Proc J.L.
        • Jordan H.
        • Docherty A.B.
        Perioperative care of people with dementia.
        Br J Hosp Med (Lond). 2020; 81: 1-9
        • White S.
        • Griffiths R.
        • Baxter M.
        • et al.
        Guidelines for the peri-operative care of people with dementia: guidelines from the Association of Anaesthetists.
        Anaesthesia. 2019; 74: 357-372
        • Hshieh T.T.
        • Yang T.
        • Gartaganis S.L.
        • et al.
        Hospital elder life program: systematic review and meta-analysis of effectiveness.
        Am J Geriatr Psychiatry. 2018; 26: 1015-1033
        • Mori E.
        • Ikeda M.
        • Kosaka K.
        • et al.
        Donepezil for dementia with Lewy bodies: a randomized, placebo-controlled trial.
        Ann Neurol. 2012; 72: 41-52
        • Peden C.J.
        • Miller T.R.
        • Deiner S.G.
        • et al.
        Improving perioperative brain health: an expert consensus review of key actions for the perioperative care team.
        Br J Anaesth. 2021; 126: 423-432
        • Tang J.X.
        • Baranov D.
        • Hammond M.
        • et al.
        Human Alzheimer and inflammation biomarkers after anesthesia and surgery.
        Anesthesiology. 2011; 115: 727-732
        • Butterworth Iv J.F.
        • Mackey D.C.
        • Wasnick J.D.
        Anesthesia for patients with neurological & psychiatric diseases.
        in: Butterworth IV JF, Mackey DC, Wasnick JD, editors. Morgan & Mikhail's Clinical Anesthesiology, 6e. McGraw-Hill Education, New York2018 (Available at: https://accessmedicine-mhmedical-com.ezproxy-v.musc.edu/content.aspx?bookid=2444&sectionid=193561247. Accessed January 6, 2021)
        • Friese M.B.
        • Crosby G.
        • Culley D.J.
        Neurologic disease and anesthesia.
        in: Cottrell J.E. Patel P. Cottrell and Patel's neuroanesthesia. 6th edition. Elsevier, Edinburgh (Scotland)2017: 399-409
        • Kim C.T.
        • Myung W.
        • Lewis M.
        • et al.
        Exposure to general anesthesia and risk of dementia: a nationwide population-based cohort study.
        J Alzheimers Dis. 2018; 63: 395-405
        • Pikwer A.
        • Castegren M.
        • Namdar S.
        • et al.
        Effects of surgery and propofol-remifentanil total intravenous anesthesia on cerebrospinal fluid biomarkers of inflammation, Alzheimer's disease, and neuronal injury in humans: a cohort study.
        J Neuroinflammation. 2017; 14: 193
        • Fan W.
        • Mai L.
        • Zhu X.
        • et al.
        The role of microglia in perioperative neurocognitive disorders.
        Front Cell Neurosci. 2020; 14: 261
        • Bimonte S.
        • Barbieri A.
        • Amruthraj N.J.
        • et al.
        Transgenic mouse models, general anesthetics, and alzheimer disease: findings from preclinical studies.
        Neuromethods. 2020; 150: 207-223
        • Ortner F.
        • Eberl M.
        • Otto S.
        • et al.
        Patient-related and anesthesia-dependent determinants for postoperative delirium after oral and maxillofacial surgery. Results from a register-based case-control study.
        J Stomatol Oral Maxillofac Surg. 2021; 122: 62-69
        • Belrose J.C.
        • Noppens R.R.
        Anesthesiology and cognitive impairment: a narrative review of current clinical literature.
        BMC Anesthesiol. 2019; 19: 241
        • Seitz D.P.
        • Shah P.S.
        • Herrmann N.
        • et al.
        Exposure to general anesthesia and risk of Alzheimer's disease: a systematic review and meta-analysis.
        BMC Geriatr. 2011; 11: 83
        • Needham M.J.
        • Webb C.E.
        • Bryden D.C.
        Postoperative cognitive dysfunction and dementia: what we need to know and do.
        Br J Anaesth. 2017; 119: i115-i125
        • Inan G.
        • Özköse Satirlar Z.
        Alzheimer disease and anesthesia.
        Turk J Med Sci. 2015; 45: 1026-1033
        • Kumar C.
        • Gopal L.
        • Seet E.
        Choosing anesthesia options for cataract surgery in patients with dementia.
        J Anaesthesiol Clin Pharmacol. 2019; 35: 81-84
        • Hussain M.
        • Berger M.
        • Eckenhoff R.G.
        • et al.
        General anesthetic and the risk of dementia in elderly patients: current insights.
        Clin Interv Aging. 2014; 9: 1619-1628
        • Berger M.
        • Nadler J.W.
        • Friedman A.
        • et al.
        The effect of propofol versus isoflurane anesthesia on human cerebrospinal fluid markers of Alzheimer's disease: results of a randomized trial.
        J Alzheimers Dis. 2016; 52: 1299-1310
        • Green C.M.
        • Schaffer S.D.
        Postoperative cognitive dysfunction in noncardiac surgery: a review.
        Trends in Anaesthesia and Critical Care. 2019; 24: 40-48
        • Müller J.
        • Nowak S.
        • Vogelgesang A.
        • et al.
        Evaluating mechanisms of postoperative delirium and cognitive dysfunction following elective spine surgery in elderly patients (CONFESS): protocol for a prospective observational trial.
        JMIR Res Protoc. 2020; 9: e15488
        • Miller D.
        • Lewis S.R.
        • Pritchard M.W.
        • et al.
        Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery.
        Cochrane Database Syst Rev. 2018; (CD012317)
        • Seitz D.P.
        • Gill S.S.
        • Bell C.M.
        • et al.
        Postoperative medical complications associated with anesthesia in older adults with dementia.
        J Am Geriatr Soc. 2014; 62: 2102-2109
        • Diaz-Gil A.
        • Brooke J.
        • Kozlowska O.
        • et al.
        Care needs of people with dementia in the peri-operative environment: a systematic review.
        Dementia. 2020; 19: 1889-1906
        • By the American Geriatrics Society Beers Criteria Update Expert P
        American Geriatrics Society 2019 Updated AGS Beers Criteria(R) for potentially inappropriate medication use in older adults.
        J Am Geriatr Soc. 2019; 67: 674-694
        • Verret M.
        • Lauzier F.
        • Zarychanski R.
        • et al.
        Perioperative use of gabapentinoids for the management of postoperative acute pain: a systematic review and meta-analysis.
        Anesthesiology. 2020; 133: 265-279
        • Renna M.
        • Handy J.
        • Shah A.
        Low baseline bispectral index of the electroencephalogram in patients with dementia.
        Anesth Analg. 2003; 96 (table of contents): 1380-1385
        • American Geriatrics Society Expert Panel on Postoperative Delirium in Older A
        American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults.
        J Am Geriatr Soc. 2015; 63: 142-150
        • Mohanty S.
        • Rosenthal R.A.
        • Russell M.M.
        • et al.
        Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society.
        J Am Coll Surg. 2016; 222: 930-947
        • Hughes C.G.
        • Boncyk C.S.
        • Culley D.J.
        • et al.
        American Society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention.
        Anesth Analg. 2020; 130: 1572-1590
        • Berger M.
        • Schenning K.J.
        • Brown C.H.T.
        • et al.
        Best practices for postoperative brain health: recommendations from the Fifth International Perioperative Neurotoxicity Working Group.
        Anesth Analg. 2018; 127: 1406-1413
        • Arora S.S.
        • Gooch J.L.
        • García P.S.
        Postoperative cognitive dysfunction, Alzheimer's disease, and anesthesia.
        Int J Neurosci. 2014; 124: 236-242
        • Sprung J.
        • Roberts R.O.
        • Weingarten T.N.
        • et al.
        Postoperative delirium in elderly patients is associated with subsequent cognitive impairment.
        Br J Anaesth. 2017; 119: 316-323
        • Racine A.M.
        • Fong T.G.
        • Gou Y.
        • et al.
        Clinical outcomes in older surgical patients with mild cognitive impairment.
        Alzheimers Dement. 2018; 14: 590-600
        • Silbert B.
        • Evered L.
        • Scott D.A.
        • et al.
        Preexisting cognitive impairment is associated with postoperative cognitive dysfunction after hip joint replacement surgery.
        Anesthesiology. 2015; 122: 1224-1234
        • Inouye S.K.
        • Marcantonio E.R.
        • Kosar C.M.
        • et al.
        The short-term and long-term relationship between delirium and cognitive trajectory in older surgical patients.
        Alzheimers Dement. 2016; 12: 766-775
        • Aldecoa C.
        • Bettelli G.
        • Bilotta F.
        • et al.
        European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium.
        Eur J Anaesthesiol. 2017; 34: 192-214
        • Hynninen N.
        • Saarnio R.
        • Isola A.
        The care of older people with dementia in surgical wards from the point of view of the nursing staff and physicians.
        J Clin Nurs. 2015; 24: 192-201
        • Siddiqi N.
        • Harrison J.K.
        • Clegg A.
        • et al.
        Interventions for preventing delirium in hospitalised non-ICU patients.
        Cochrane Database Syst Rev. 2016; (CD005563)
        • Donovan A.L.
        • Braehler M.R.
        • Robinowitz D.L.
        • et al.
        An implementation-effectiveness study of a perioperative delirium prevention initiative for older adults.
        Anesth Analg. 2020; 131: 1911-1922
        • Kolanowski A.M.
        • Hill N.
        • Clare L.
        • et al.
        Practical protocol for implementing cognitive stimulation in persons with delirium superimposed on dementia.
        Nonpharmacol Ther Dement. 2012; 2: 101-110
        • Kolanowski A.
        • Fick D.
        • Litaker M.
        • et al.
        Effect of cognitively stimulating activities on symptom management of delirium superimposed on dementia: a randomized controlled trial.
        J Am Geriatr Soc. 2016; 64: 2424-2432
        • Warden V.
        • Hurley A.C.
        • Volicer L.
        Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale.
        J Am Med Dir Assoc. 2003; 4: 9-15
        • Malara A.
        • De Biase G.A.
        • Bettarini F.
        • et al.
        Pain assessment in elderly with behavioral and psychological symptoms of dementia.
        J Alzheimers Dis. 2016; 50: 1217-1225
        • Vaurio L.E.
        • Sands L.P.
        • Wang Y.
        • et al.
        Postoperative delirium: the importance of pain and pain management.
        Anesth Analg. 2006; 102: 1267-1273
        • Guarnieri B.
        • Adorni F.
        • Musicco M.
        • et al.
        Prevalence of sleep disturbances in mild cognitive impairment and dementing disorders: a multicenter Italian clinical cross-sectional study on 431 patients.
        Dement Geriatr Cogn Disord. 2012; 33: 50-58
        • McCurry S.M.
        • Logsdon R.G.
        • Teri L.
        • et al.
        Characteristics of sleep disturbance in community-dwelling Alzheimer's disease patients.
        J Geriatr Psychiatry Neurol. 1999; 12: 53-59
        • Cipriani G.
        • Lucetti C.
        • Danti S.
        • et al.
        Sleep disturbances and dementia.
        Psychogeriatrics. 2015; 15: 65-74
        • Bombois S.
        • Derambure P.
        • Pasquier F.
        • et al.
        Sleep disorders in aging and dementia.
        J Nutr Health Aging. 2010; 14: 212-217
        • Brown C.A.
        • Berry R.
        • Tan M.C.
        • et al.
        A critique of the evidence base for non-pharmacological sleep interventions for persons with dementia.
        Dementia (London). 2013; 12: 210-237
        • Hu R.F.
        • Jiang X.Y.
        • Chen J.
        • et al.
        Non-pharmacological interventions for sleep promotion in the intensive care unit.
        Cochrane Database Syst Rev. 2015; (CD008808)
        • Litton E.
        • Carnegie V.
        • Elliott R.
        • et al.
        The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: a systematic review and meta-analysis.
        Crit Care Med. 2016; 44: 992-999
        • Su X.
        • Wang D.X.
        Improve postoperative sleep: what can we do?.
        Curr Opin Anaesthesiol. 2018; 31: 83-88