Molecular and Clinical Considerations for Anesthesia in the Aging Brain

Area of Science:

• Neuroscience
• Gerontology
• Anesthesiology

Background:

• Postoperative neurocognitive disorders (PNDs) are cognitive dysfunctions occurring after surgery.
• PNDs present with varied symptoms (lethargy, confusion) and impact all age groups, with incidence rising in older adults.
• Prompt recognition of PNDs is crucial due to increased morbidity, mortality, and healthcare utilization.

Purpose of the Study:

• To review the molecular basis of brain aging.
• To explore anesthesia's role in PND development.
• To identify mechanisms linking brain aging and PND pathophysiology.

Main Methods:

• Literature review focusing on molecular mechanisms of brain aging.
• Analysis of anesthesia's impact on neurocognitive function.
• Examination of PND pathophysiology, including neuroinflammation, oxidative stress, mitochondrial dysfunction, and synaptic disruption.

Main Results:

• Brain aging shares pathophysiological parallels with PNDs, including neuroinflammation and oxidative stress.
• Potential therapeutic targets include dexmedetomidine and NSAIDs for their anti-inflammatory properties.
• EEG-guided anesthesia and judicious anesthetic selection may reduce PND incidence.

Conclusions:

• Understanding brain aging mechanisms is key to managing PNDs.
• Targeting neuroinflammation and oxidative stress shows promise for PND mitigation.
• Tailored anesthetic management and supportive care are essential for preventing and treating PNDs.