Surgery, neuroinflammation and cognitive impairment
| Autor: | Ka Chun Suen, Zac Hana, Daqing Ma, Zhaosheng Jin, Azeem Alam |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Multiple organ dysfunction syndrome MEDLINE Ibuprofen Review General Biochemistry Genetics and Molecular Biology 03 medical and health sciences 0302 clinical medicine Postoperative Complications Neuroinflammation Brain Injuries Traumatic medicine Dementia Animals Humans Therapeutic targets Cognitive Dysfunction Dexmedetomidine Inflammation business.industry Cognition General Medicine medicine.disease Surgery Systemic inflammatory response syndrome 030104 developmental biology Delirium medicine.symptom Hydroxymethylglutaryl-CoA Reductase Inhibitors business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | EBioMedicine |
| ISSN: | 2352-3964 |
| Popis: | Trauma experienced during surgery can contribute to the development of a systemic inflammatory response that can cause multi-organ dysfunction or even failure. Post-surgical neuroinflammation is a documented phenomenon that results in synaptic impairment, neuronal dysfunction and death, and impaired neurogenesis. Various pro-inflammatory cytokines, such as TNFα, maintain a state of chronic neuroinflammation, manifesting as post-operative cognitive dysfunction and post-operative delirium. Furthermore, elderly patients with post-operative cognitive dysfunction or delirium are three times more likely to experience permanent cognitive impairment or dementia. We conducted a narrative review, considering evidence extracted from various databases including Pubmed, MEDLINE and EMBASE, as well as journals and book reference lists. We found that further pre-clinical and well-powered clinical studies are required to delineate the precise pathogenesis of post-operative delirium and cognitive dysfunction. Despite the burden of post-operative neurological sequelae, clinical studies investigating therapeutic agents, such as dexmedetomidine, ibuprofen and statins, have yielded conflicting results. In addition, evidence supporting novel therapeutic avenues, such as nicotinic and HMGB-1 targeting and remote ischaemic pre-conditioning, is limited and necessitates further investigation. Highlights • Recent studies have demonstrated that surgery can cause neuroinflammation. • Post-surgical neuroinflammation can cause reversible and irreversible neurological sequelae, such as delirium and dementia. • Neuroinflammatory mechanisms include microglial activation, blood-brain barrier dysfunction, and subsequent neuronal damage. • Currently licensed medications have demonstrated the ability to attenuate neuroinflammation, but results remain conflicting. • More studies are needed to develop therapeutic approaches to tackle neuroinflammation and its associated neurological effects. |
| Databáze: | OpenAIRE |
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