Anesthésie et démence

Dementia is the consequence of a chronic and progressive decline in cognitive function. Preoperative evaluation of patient's cognitive status is recommended. Information about the risk of postoperative cognitive dysfunction must be provided to those it may concern. Postoperative worsening of mental function may have indeed significant consequences for patients and their relatives. Pharmacodynamics of anaesthetic agents is impaired by physiological and pathological ageing. Long-term effects of anaesthetic agents may account for postoperative cognitive dysfunction. This issue requires clinical trials to be performed in aged patients and those suffering from cognitive decline who are commonly excluded from other kind of clinical studies. Preoperatively, it is recommended to perform a Mini Mental Test to stop anticholinergic treatments, to continue anticholinesterasic medications and to avoid the use of benzodiazepines. Patients should be enrolled as the first ones of the surgical list. Muscle relaxants should be monitored during anaesthesia. Patients should be managed preferably in day-case surgery; otherwise, cooperation with the relatives is helpful during conventional hospitalization.