Study Shows the Relationship Between Surgery and Alzheimer’s Disease

Summary: Major surgery can trigger different patterns of cognitive alterations depending on previous presence, or absence, of Alzheimer’s pathologies.

Source: IOS Press

 A new study published in the Journal of Alzheimer’s Disease carried out by researchers at the Marqués de Valdecilla-IDIVAL University Hospital, in collaboration with researchers at the University of Bonn Medical Center, proposes that major surgery is a promoter or accelerator of Alzheimer’s disease (AD). The first author of the publication was Carmen Lage and the principal investigator Pascual Sánchez-Juan.

AD is one of the greatest public health challenges. From the moment the first lesions appear in the brain to the clinical manifestations, up to 20 years can pass. Today we can detect the presence of these initial lesions through biochemical markers such as amyloid-β, which is one of the main proteins accumulated in the brains of Alzheimer’s patients. The frequency of amyloid-β deposits in healthy people increases with age, and after 65 years of age, they would be present in up to one-third of the population. However, it is not well known what determines how in amyloid-β carriers the disease progresses more or less rapidly towards dementia or even remains inactive.

Carmen Lage said: “Although the phenomenon of cognitive deterioration after surgery has been known for a long time, there are few studies that relate it to AD. In the clinic, the patient’s relatives frequently tell us that memory problems began after a surgical procedure or a hospital admission. This posed the following question: Is this just a recall bias or has surgery triggered the appearance of the symptoms in a previously affected brain?”

This is the question that motivated the work developed by researchers from the Marqués de Valdecilla University Hospital-IDIVAL exploring the relationship between cerebrospinal fluid (CSF) amyloid-β levels and surgery.

The researchers administered cognitive tests to healthy individuals over the age of 65 before undergoing orthopedic surgery; obtained samples of CSF to determine amyloid-β levels during anesthesia; and then administered the same tests again nine months later.

The main result was that half of the patients’ cognition worsened compared to their state before surgery, and those who had altered amyloid-β levels exhibited a pattern compatible with the onset of AD, in which memory problems predominated.

Carmen Lage said: “Before the surgery, the memory test scores of the subjects with abnormal amyloid-β levels were indistinguishable from those of subjects with normal levels, and yet after surgery, they were significantly worse. These results lead us to the conclusion that major surgery can trigger different patterns of cognitive alterations, depending on the previous presence or absence of Alzheimer’s pathological changes.

This is a computer generated image of a brain made up of computerized neurons
The main result was that half of the patients’ cognition worsened compared to their state before surgery, and those who had altered amyloid-β levels exhibited a pattern compatible with the onset of AD, in which memory problems predominated. Image is in the public domain

While subjects without amyloid-β pathology showed a deterioration that does not affect memory, probably associated with factors intrinsic to the surgery itself, those with amyloid-β pathology suffered a cognitive deterioration that predominantly affected memory, and which was consistent with the first clinical manifestations of AD and therefore associated with greater probabilities of progression to dementia.”

Dr. Pascual Sanchez-Juan added: “The progressive aging of our societies and the improvement in surgical technique mean that more and more elderly and fragile individuals are undergoing surgery. Pre-surgical evaluation always assesses whether cardiac or respiratory function will withstand the surgery, however, the potential consequences of the operation for the patient’s brain are not usually determined. Our results would advocate that pre-surgical evaluation studies include cognitive tests, and even the analysis of Alzheimer’s biomarkers, especially once these become widely available in plasma.”

About this Alzheimer’s disease research news

Source: IOS Press
Contact: Diana Murray – IOS Press
Image: The image is in the public domain

Original Research: Closed access.
Major Surgery Affects Memory in Individuals with Cerebral Amyloid-β Pathology” by Carmen Lage et al. Journal of Alzheimer’s Disease


Major Surgery Affects Memory in Individuals with Cerebral Amyloid-β Pathology

Background: Major surgery has been associated with perioperative neurocognitive disorders (PND), but the contributing factors and long-term prognosis are uncertain. We hypothesize that preclinical Alzheimer’s disease (AD) might predispose to cognitive deterioration after surgery.

Objective: To analyze the effect of amyloid-β on the cognitive trajectory after orthopedic surgery in a sample of non-demented subjects. Methods:Non-demented individuals older than 65 years that were on the waiting list for orthopedic surgery with spinal anesthesia underwent a neuropsychological assessment before and after surgery. During surgery, cerebrospinal fluid samples were obtained to determine AD biomarkers.

Results: Cumulative incidence of PND was 55.2%during a mean follow-up of nine months. The most affected cognitive domains were executive function and constructional praxis. The presence of abnormal levels of amyloid-β was associated to a postoperative impairment in verbal and visual memory tests. According to their AD biomarker profile, participants were categorized as either Amyloid Positive (A+) or Amyloid Negative (A-). The incidence of PND did not differ between both groups. The A- group showed a tendency similar to the global sample, worsening in executive function tests and improving on memory scales due to practice effects. In contrast, the A + group showed a notable worsening on memory performance.

Conclusion: Our findings support the hypothesis that surgery may promote or accelerate memory decline in cognitively asymptomatic subjects with brain amyloid-β deposits.

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  1. My husband had by-pass in 1999. Have always felt it opened the door to AD. Not alone others have remarked the same after loved ones had surgery.

  2. Uhm yeah! Systemic infection sets in(similar to chronic Lyme with multiple coinfections. Bam, the prions go to the brain and there you have it; lethal neurodegenerative disease- see the works of pathologist Alan Macdonald.)

  3. Would appreciate more info! I have had numerous major surgeries and have lost large blocks of time in my memory over the last 30+ years. Currently awaiting a couple more surgeries but this article makes me reticent. Also recently have had numerous nuclear tests on brain and heart, could these also be related to memory loss?

  4. Perhaps leaving internal organs “open” to indoor air, provides too much exposure to pathogens or free radicals in the air, without skin to purposefully filter out unwanted particles.
    Introduction of such particles could risk causing disease or infection, which will accelerate AD; arguably moreso than a one off use of an anaesthetic — due to the chronic nature of some infections and diseases and resulting deleterious effects on physiological systems, including the brain.

    However, the type of anaesthesia used may also be an important factor — as some drugs do worsen AD, although I thnk there is something specific to the surgical process that is mostly responsible for this relationship.

  5. Perhaps it is not due to the surgery, but rather the anaesthesia (hypoxia in an aged brain for instance?). Maybe an animal model could be developed to test this theory as it would be unethical to try on humans.

  6. This was very fascinating. I wonder if the cause of this amyloid-B increase is connected to undergoing full anesthesia – maybe the patients had a reaction to the drugs used for full anesthesia.

    1. Yes Hannah, and Kenneth, that was exactly the objective of the study.
      To analyze the effects of spinal anesthesia on the brain. ??

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