Monitoring and Targeting Dementia

By Carla Todaro, MD, from the IARS, AUA and SOCCA 2019 Annual Meetings*

The 2019 International Science Symposium, Dementia: Let’s Stop Losing Our Minds, moderated by Christian P. Werner, MD, Medical Center of Johannes Gutenberg Universität, focused on the prevalent topic of dementia and how to more effectively target treatment of this condition. Three thought leaders in this specialty, Sandra E. Black, OC, Oont, MD, FRCP(C), FRSC, FAAN, FAHA, University of Toronto, E. Wes Ely, MD, PhD, Vanderbilt University School of Medicine, and Erik S. Musiek, MD, PhD, Washington University School of Medicine, challenged the audience to critically analyze different mechanisms and contributing factors which can lead to dementia and identify strategies for discovering solutions.

Dr. Black explained the mechanisms at the base of neurodegeneration processes and how mixed pathologies are common in the Alzheimer’s syndrome in her presentation titled, “Dementia Update: What’s New in the Field.”

Reviewing the progress made in the discovery of different pathogenetic mechanisms generated in Alzheimer’s, Dr. Black shows the chronological advancement of research that has not been embarked upon until now on this topic, and the advancement of new therapies, including immunotherapy, for primary prevention.

Dr. Ely focused on “Clinical Illness: What Matters in the Mind” and analyzed possible correlation between global cognition impairment and surgical exposure. It is important to discriminate between global cognitive dysfunction and executive function. Different studies have demonstrated that individuals with executive dysfunction also have increased risk of mortality.

The onset of postoperative delirium should be assessed and monitored in the ICU with a simple tool such as the CAM-ICU as noted in a study by Dr. Ely. 

Delirium can be managed using this acronym, “Dr DRE,” which stands for: Disease remediation, Drug Removal, Environment.

Dr. Ely recommended that anesthesiologists should modify their practice in ICU by follow this process:

1. Analgesia
2. Stop drugs and ventilation
3. Choice analgesia and sedation
4. Assess delirium
5. Do early mobilization
6. Family involvement

Dr. Musiek concluded the session with a presentation on “Mechanisms of Mind Loss: The Clock is Ticking.”

Circadian dysfunction is present in different neurodegenerative diseases, most of which are associated with neuroinflammation. Dr. Musiek explained that circadian rhythm dysfunction and inflammation seem to be related. Rev-erbα, a nuclear receptor and circadian clock component, plays a role in neuroinflammation generation. A study, conducted on mice, has demonstrated that Rev-erbα deletion can be the cause of inflammation.

Another core clock protein BMAL1 regulates astrocyte activation and function in vivo, explaining its influence on brain function and neurological disease development. The time of the day for surgery may influence a patient’s outcome.

The expert speakers concluded the session by emphasizing the importance of continuing to examine the ways we treat and approach dementia.

*Coverage from the International Science Symposium: Dementia: Let’s Stop Losing Our Mind  during the IARS 2019 Annual Meeting