Dementia With Lew Body

Abstract

Patients who have dementia with Lewy bodies (DLB) and undergo surgery may develop aggravated postoperative cognitive dysfunction or postoperative delirium. Many patients with DLB respond poorly to surgery and anesthesia, and their conditions may worsen if they have other medical complications along with dementia. They may also face high risk of prolonged hospital stay, increased medical problems and/or mortality, causing significant physical, psychosocial, and financial burdens on individuals, family members, and society. Anesthesia, pain medications, old age, and surgery-related stresses are usually held responsible for the complications; however, the exact causes are still not fully understood. Literature on surgery-related complications for patients with DLB appears to be inadequate, and hence the topic merits detailed and systematic research. This article reviews postoperative complications and various surgery-related risk factors for DLB in light of other dementias such as Alzheimer's disease, as their neuropathologic features overlap with those of DLB.

Olfactory dysfunction is related to postoperative delirium in Parkinson’s disease

“…The most common treatment for delirium is the use of anti-dopaminergic medications; however, these medications are known to exacerbate motor symptoms in patients with both PD and DLB (Pervin et al 2015). Early identification of high-risk individuals may enable targeted prevention strategies such as cholinesterase inhibitor (Gamberini et al 2009;van Eijk et al 2010), which may reduce some of the adverse impacts of postoperative delirium, including the higher frequency and duration of ICU stays, and greater chance of discharge to nursing facilities or dementia (Davis et al 2012;Gleason et al 2015).…”

“…While little is known regarding the underlying pathophysiology of delirium, inflammation, sympathetic tone and neurodegeneration are thought to play important roles (Androsova et al 2015). Surgery under general anesthesia often leads to delirium in elderly patients, particularly those with impaired cognition, suggesting that underlying neuropathology may play a role in the development of postoperative delirium (Gleason et al 2015;Pervin et al 2015). Early identification of patients at a greater risk for postoperative delirium would allow for targeted intervention prior to surgery (van Eijk et al 2010), which may help reduce both the frequency and severity of adverse consequences (Gleason et al 2015).…”

Psychosocial support for people with dementia with Lewy bodies

“…• Advice can be given about important specific health information including a greater sensitivity to anaesthetics (Pervin et al, 2016) • The opportunity to participate in DLB related research that may benefit others in the future…”