Dementia and Neurologic Syndromes: Distinctions Between Alzheimer’s, Vascular Dementia, and Parkinson’s

Abstract

Overview Age-associated neurologic disease can be an important determinant of functional outcome after surgery. Neurologic diseases in the elderly encompass many diver-gent conditions such as Alzheimer's disease, Parkinson's disease with dementia, cerebrovascular disease, and neurologic effects of other systemic disease. The com-mon elements among the dementias are cognitive decline and a secondary impair-ment in functional outcome. Any stressor, including surgery and anesthesia, can potentially cause acute deterioration in cognition and function. It is important to identify pre-existing neurologic de fi cits and establish the patient's baseline prior to surgery and anesthesia. Proper preoperative examination can reduce frustration and unnecessary testing when trying to distinguish between preoperative diagnoses and new fi ndings after emergence from anesthesia. Furthermore some neurologic conditions may require speci fi c management such as Parkinson's disease. Additionally, neurologic disease may increase the risk of speci fi c complications that may affect functional recovery in both the short-term and long-term. Optimum recov-ery of function after an operation requires the interplay between cognitive and physi-cal health, and both must be maximized for full functional recovery. Dementia is the most common age related neurologic illness. The prevalence of dementia will increase and also continues to grow in the Western population. Dementia is increasingly recognized as a predictor of poor outcome and morbidity after surgery. For these reasons, awareness of dementia and its effect on an anes-thetic is the fi rst step toward reducing morbidity and functional impairment in this vulnerable population.