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August 2017 Newsletter

Alzheimer’s And Anesthesia

Hospital

Over the years I have heard from many families that their older adult who underwent surgery with a general anesthetic had lasting cognitive changes.

Recently I came across an excellent article by Sydney S. Farrier, LCSW on this subject. The article offers research that Alzheimer's and anesthesia don't mix well.

Here is information from the article.

A report from researchers from Massachusetts General Hospital indicates that research with mice given an anesthetic commonly used in surgeries found "changes to their brains similar to the damage found in Alzheimer's disease."

Knowing that older people in particular are at risk for experiencing cognitive problems after anesthesia, Dr. Zhongcong Xie at Mass General Institute for Neurodegenerative Disease gave mice doses of isoflurane for two hours and then compared them to mice that did not receive the anesthetic.

"After six hours, there were signs that programmed cell death was beginning and levels of an enzyme that makes amyloid-beta protein were rising in the brains of mice that were given isoflurane. After 24 hours, the enzyme was four times higher in mice who had received isoflurane than in untreated mice, supporting the idea that the anesthetic not only triggers cell death but also spurs excessive production of amyloid-beta protein."

Dr. Roderic Eckenhoff, an anesthesiologist and researcher at the University of Pennsylvania, states, “We give these drugs to tens of millions of patients every year, and blithely ignore that they could have long-term effects.”

Researchers explain that, with scarce clinical data, it is premature to change operating room procedures, but some physicians are advising their patients that are already diagnosed with Alzheimer’s to avoid surgery unless absolutely necessary.

Article - Does Anesthesia Cause Dementia or Memory Loss in the Elderly?

Others, like Dr. Rudy Tanzi, of Mass General in Boston, are selective about which inhaled anesthesia is used when surgery is unavoidable. When his mother required a surgery, he requested that the anesthesiologist use desflurane rather than isoflurane. He reports that his mother woke from surgery clear headed and without the fuzziness and confusion that she had experienced for several days following previous surgeries.

Isoflurane is an inhaled general anesthetic that is often used in cardiac bypass surgery.

Topic - Dementia made worse by anesthesia

A January 2007 article in Biochemistry included an article from the University of Pittsburgh School of Medicine that indicated that inhaled anesthetics are more likely to cause a clumping of plaque than intravenous anesthetics.

Inhaled anesthetics of halothane and isoflurane appeared to have the "most potent interaction with amyloid-beta peptides and aggregation.

Sevoflurane is another inhaled anesthetic that can be avoided. Injected anesthetic propofol showed this result only at high concentrations. More research is required and research with human trials needs to take place.

I do agree with the author that “If you must undergo a surgery, have a serious and frank conversation with your surgeon and the anesthesiologist about the type of anesthesia to be used, the possible effects on your brain, and what alternatives are available”.

Article courtesy of the Alzheimer’s reading room 2017


Identifying and Treating Memory Issues is Better with a Team of Providers Experienced in The Care of the Elderly

Puzzle

Guest Contributor: Dr. Terri Katz

All too often, when the elderly experience any changes in their physical or psychological functioning, it is attributed to aging. In fact, that assumption is unfortunate, because the symptoms often could be an indication of an underlying condition for which there is a reasonable intervention. For instance, memory changes do not necessarily indicate onset of dementia; sometimes changes in memory are related to depression. Undiagnosed depression is a serious problem that once identified can be mitigated with pharmacological and behavioral therapies.

Changes in cognition with aging have emerged as an important public health concern. As many as 76% of elderly with memory loss of varying degrees go undiagnosed. The Institute of Medicine recommends that health care professionals be on the forefront of screening, identifying, and managing cognitive aging. Evaluating memory decline and implementing recommendations requires a coordinated effort from different disciplines, involving the patient, and often, their family and friends. Individuals should be assessed to determine whether their memory issues are medically and/or psychologically based. The comprehensive evaluation can be tailored to individuals’ specific needs might include any or all of the following: neuropsychological testing, full medical evaluation, depression and anxiety screening, and lifestyle assessment. Treatments may include medication, psycho-education, mindfulness training, meditation and stress management, physical therapy, nutritional assessments and referral to community resources.

After a comprehensive evaluation, there are recommend strategies for bolstering quality of life.

Recent evidence suggests that exercise and social connections can begin to counteract some memory loss. In fact, The Institute of Medicine convened a 16- member expert panel, which highlighted several areas of intervention for patients and their families to maximize cognitive functioning;

education regarding the positive connection between regular physical exercise and improved cognitive health.

reducing cardiovascular risk factors such as Diabetes Mellitus, Hypertension, and smoking to improve brain health.

maintaining social activities, continuing lifelong learning, and promoting good sleep hygiene to optimize cognition.

Dr. Terri Katz, Dr. Sandy Bell-McGinty and Ms. Lisa Fedder, LCSW, LCADC are excited to announce their partnership in NEXT – Because Memory Matters. They are devoted to promoting memory enhancement and improving quality of life.

The NEXT professionals recognize that the elderly are frequently bombarded by conflicting recommendations from multiple physicians as well as television and other media promoting various treatments for many ailments. It is very important that there be one person who can rigorously review both prescribed and over the counter medications with a goal of simplifying the regimen and only continuing with medications that are consistent with established goals of care. Establishing goals of care is paramount though not always so easy to do. Drs. Katz and McGinty, along with Psychotherapist/ Social Worker Lisa Fedder have expertise in this area.

Dr. Terri Katz is a magna cum laude graduate from the University of Pennsylvania and received her medical degree from George Washington University. She is board certified in both Internal and Geriatric Medicine. In creating The Center for Dynamic Aging in 2003 Dr. Terri Katz has succeeded in reaching a goal of bringing her expertise in Geriatrics to Bergen County. With compassion and care, she devotes herself to meeting the medical and psychosocial needs of elderly patients, and helping their families adjust to changing care-giving roles. Dr. Katz is dedicated to helping this community maintain the highest quality of life for its elderly members, and is committed to disseminating information through consultation, seminars, and publications, and by working with the community agencies that provide services to the elderly.


How to Manage Reluctance to Taking Medication

Pills

As dementia progresses, individuals with this illness can resist taking medication. What can contribute to resistance or reluctance to taking medication can be caused by the individual’s confusion, lack of understanding, sleep problems, and/or restlessness. For some individuals, they hear what is being said i.e., “it’s time to take your medication” or here’s your medication” but can no longer comprehend and process what are the steps to be taken to “take medication”.

To be effective and successful here are some strategies:

  • Timing: Set up a routine time to administer medications and if possible connect it with something pleasant, such as a meal or snack. Caregivers should put aside ample time to administer medication since the processing speed of an individual with dementia is often slowed down. Try to administer medications when the person is most alert and calm.
  • Stimulating Surroundings: The individual with dementia often can not process multiple sources of stimulation. If possible administer medications in the same location (dining room table, bathroom) and eliminate distractions such as noise, or too much activity.
  • Attitude of Caregiver: Having to administer medications can often become a battlefront for caregivers. Again, caregivers need to give themselves enough time to focus to “get the job done”. Even though it is challenging find ways to make it cheerful. Speak with a friendly calm tone of voice, and convey a positive welcoming experience through your body language. Caregivers certainly can feel frustrated but if this is conveyed the individual with dementia can pick up on the negative feelings but don’t comprehend what is the problem. Again, with dementia there is a diminished ability to process and comprehend.

Caregivers you are not alone in dealing with this challenge.

In addition to the above mentioned suggestions, some medications can be given unnoticed to the individual when combined with food such as apple sauce or ice cream. Before you give this a try, consult with the doctor prescribing the medication.

For additional tips and suggestions tailored to your situation, don’t hesitate to contact me.

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