Most anaesthetics involve the use of antagonists of the muscarinic and nicotinic neuronal acetylcholine receptors. When active, these pathways serve to regulate Amyloid-B protein synthesis. Thus, there seems to be a link between the inhibition of these pathways and the increase in the Amyloid-B protein in its insoluble form (the precursor for plaque generation). Also some anaesthetics have been shown to affect oligomerisation of the amyloid beta peptide to it's insoluble beta sheet form.
Some anaesthetics have also been shown to induce apoptosis in neuroglioma cell lines in the brain. Apoptosis is said to increase the cleavage of amyloid precursor to B-amyloid peptide, which increases its aggregation into plaques, causing further apoptosis, resulting in a vicious cycle of apoptosis, aggregation of beta amyloid, and further apoptosis.
POCD is most prevalent in the elderly because they already have a higher concentration of the Amyloid protein in their brain. The incidence of POCD is increasing because with the longer life expectancy in humans, older and older people are undergoing more serious surgeries so we are seeing more cases of the unfortunate disease. However, because there seems to be this mechanistic link between POCD and Alzheimer's, it is giving researchers insight and more ideas into the progression and molecular causes of Alzheimer's Disease. If you would like to read the review on POCD, the link is below.
http://xa.yimg.com/kq/groups/1099152/1976222979/name/alzg.pdf
I had no idea that this POCD was a condition. We often hear of how surgeries become riskier as you become older, but I didn't know dementia was one of the risks. I wonder if we could find an alternative to anesthesia that doesn't affect the beta amyloid, lowering the risk of POCD.
ReplyDeleteI found a lay article on the Science Daily website about an alternative medication to anesthesia. This new method is called Nerve Block. Anesthesiologists use ultrasound to locate nerves, then inject a nerve numbing medication into the area. The medication is a local anesthetic, but the precise point of administration allows pain-free surgery without losing consciousness.
ReplyDeleteI know Nerve block method still uses local anesthetic but it can keep the patient awake throughout their surgeries. Maybe this will help a little in preventing POCD.
Article found at: http://www.sciencedaily.com/videos/2007/1109-surgery_without_anesthesia.htm
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