Alzheimer Disease

Postoperative delirium risk - The demented brain is highly prone to postoperative delirium and further decline; minimize precipitants — use short-acting agents, avoid deliriogenic drugs where possible, control pain, and reorient early.

Drug sensitivity - Reduce doses of centrally acting agents; these patients are sensitive and clear drugs more slowly.

Cholinesterase inhibitors - Common therapy (donepezil, rivastigmine) can prolong succinylcholine and blunt the response to some agents; review medications and monitor neuromuscular function.

Consent and cooperation - Capacity may be impaired; involve caregivers and surrogates and plan for limited cooperation with regional or awake techniques.

Calm perioperative environment - Familiar caregivers, minimal disruption, and careful sedation help; avoid over-sedation.

Alzheimer disease is the most common cause of dementia — a progressive neurodegeneration marked by amyloid plaques and neurofibrillary tangles causing memory loss, cognitive decline, and eventual loss of function.

For the anesthetist the issues are less a specific organ derangement than the vulnerable, often elderly brain: a heightened risk of postoperative delirium and cognitive decline, sensitivity to centrally acting drugs, difficulty with consent and cooperation, and interactions with cholinesterase-inhibitor therapy.