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BJA Advance Access published online on September 1, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael233
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted June 6, 2006

Review Article

Alzheimer's disease and anaesthesia: implications for the central cholinergic system

V. Fodale 1 *, D. Quattrone 1, C. Trecroci 1, V. Caminiti 1, and L. B. Santamaria 1

1 Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, University of Messina, School of Medicine, Policlinico Universitario ‘G. Martino’, via C.Valeria, 98125 Messina, Italy

* To whom correspondence should be addressed.
V. Fodale, E-mail: vfodale{at}unime.it


  Abstract

Alzheimer's disease (AD) is associated with a loss of cholinergic neurons resulting in profound memory disturbances and irreversible impairment of cognitive function. The central cholinergic system is involved in the action of general anaesthetic agents. Anaesthetic modulation of cholinergic transmission has profound effects on brain function via a cascade of synaptic and postsynaptic events by binding both nicotinic and muscarinic receptors. During general anaesthesia, decrease in acetylcholine release and depression of cholinergic transmission facilitates the desirable effects of general anaesthetics, such as loss of consciousness, pain, voluntary movements and memory. From this point of view, patients with AD, characterized by a compromised neuronal transmission, represent particular cases in which the choice of anaesthesia drugs may have a negative effect on the postoperative outcome. A future challenge may be the identification of brain targets of general anaesthetics which do not expose patients to postoperative cognitive dysfunction, nor interfere with prognosis of brain degenerative disease.

Keywords: acetylcholine, central cholinergic system; Alzheimer's disease; anaesthesia, general; complications, recovery; cognitive dysfunction.
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T.C. Collyer, R. Frater, V. Fodale, and (on behalf of all co-authors)
Alzheimer's disease and anaesthesia
Br. J. Anaesth., May 1, 2007; 98(5): 692 - 694.
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