There is growing global concern regarding the potential neurotoxicity of anesthetics.
Biophysical and animal model studies have identified molecular changes simulating Alzheimer's disease (AD) pathology after exposure to inhaled anesthetics. This research has alerted anesthesiologists, neuropsychologists, surgeons and other clinicians to initiate in-depth clinical research on the role of anesthetics in post operative cognitive decline.
AD is a devastating disease commonly found in elderly persons and an enormous world health problem. It is manifested by severe memory loss, language problems, impaired decision making and affected activities of daily living. The human population is aging with increase in life expectancy. Therefore, we are confronted with increases in the number of persons at risk of developing AD and also the number of elderly undergoing surgical procedures. Any possible association between the two therefore merits careful consideration.
In the absence of either a single coherent etiological model to explain the cause of AD or an effective treatment, a consistent part of funding for research in AD is currently aimed at identifying risk factors as well as delaying the clinical manifestations of the disease. Recent research has focused on reduction of disease incidence through identification of risk factors. In this context the question of the association between AD and anesthesia has again been raised.
A supplement to the Journal of Alzheimer's Disease on "Anesthetics and Alzheimer's Disease" provides the platform to bring the latest scientific studies to the AD research and clinical communities. Leading scientist and guest Editors Dr. Pravat K Mandal from the National Brain Research Centre, a world class neuroscience centre located in India, and Dr. Vincenzo Fodale from the University of Messina, Italy, a university recognized globally for advanced research, have brought together the latest research results from scientists, neurologists, physicians, neuropsychologists, and anesthesiologists on various aspects of the pathophysiology of AD and the role of anesthetics as a possible risk factor.
Highlights of special issue are:
• Cellular and molecular pathology in AD
• Influence of anesthetic size on Aβ oligomerization established using state-of-the-art NMR spectroscopic technique (a fundamental contribution in this area of research)
• Evidence from animal model studies indicating more plaque formation in transgenic mice treated with inhaled anesthetics like halothane or isoflurane
• Association between impairment of cholinergic neurons and cognitive deficits in AD patients; and the possible role of anesthetics in cholinergic dysfunction
• Multifactorial etiology, including the type of anesthesia, apolipoprotein E genotype, and the presence of co-morbid disorders, in the development of long-term post-operative cognitive decline
• Anesthesia in patients with dementia; noteworthy clinical antecedents and peri-operative risk management in AD
Guest Editors Drs. Mandal and Fodale emphasized that "this special issue is a cornerstone in the effort to update and clarify the possible linkages between common anesthetics given to millions of patients every day and the pathomechanism of AD, thus contributing to an ongoing constructive debate. The Editors of the supplement do not intend to engender a 'fear of anesthesia' that could lead to irrational rejection of surgery in later life, but they hope to encourage the earnest quest for the 'safe anesthetic' for the elderly and more research are warranted."
Dr. Mandal stated that "the publication of this issue is most timely and it will add value, depth, and advancement to the current scientific knowledge in this area."