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The New Frontier of Perioperative Cognitive Medicine for Alzheimer’s Disease and Related Dementias

Abstract

This is a review of preoperative cognitive assessment and other healthcare gaps in the care of older adults at risk for Alzheimer’s disease and related dementias (ADRD) who have elected surgery with anesthesia. It summarizes concerns regarding ADRD perioperative healthcare, perioperative cognitive, and neuronal domains of vulnerability. It also offers a plan for phased preoperative cognitive screening and perioperative cognitive intervention opportunities. An argument is made for why medical professionals in the perioperative setting need fundamental training in cognitive-behavioral principles, an understanding of neurodegenerative diseases of aging, and an appreciation of the immediate and long-term medical risks for such patients undergoing anesthesia. The author’s goal is to encourage readers to consider perioperative cognitive medicine as a new frontier for generating evidence-based care approaches for at-risk older adults with neurodegenerative disorders who require procedures with anesthesia.

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Acknowledgements

I sincerely thank the reviewers for their comments and Shawna Amini, MPH, and Christina Hendricks, B.S, for the Figure 3 infographic. Thank you to Laura Anderson for her time editing this manuscript.

Funding

Support was provided through K07 AG066813 and a Paul Satz Term Professorship. Perioperative and neurodegenerative research and career research training were provided through R01 NS082386, K23 NS060660, NIA R01 AG055337, NSF 13–543, and R01 NR014810.

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Correspondence to Catherine C. Price.

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Price, C.C. The New Frontier of Perioperative Cognitive Medicine for Alzheimer’s Disease and Related Dementias. Neurotherapeutics 19, 132–142 (2022). https://doi.org/10.1007/s13311-021-01180-w

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Keywords

  • Anesthesia
  • Cognitive disorders
  • Evidence-based medicine
  • Delivery of health
  • Delirium
  • Neuropsychology