Is Childhood General Anesthesia Exposure An Etiological Contributor to Cognitive Impairment?

2021 ◽  
Vol 36 (3) ◽  
pp. 251-259
Author(s):  
Yi Tian ◽  
Peiyu Liu ◽  
Weisong Liu ◽  
Qiaojing Xu ◽  
Xiangkun Zhao
Keyword(s):  
Risk Factors ◽  
Early Childhood ◽  
Cognitive Impairment ◽  
General Anesthesia ◽  
Strong Correlation ◽  
Clinical Studies ◽  
Clinical Evidence ◽  
Preclinical Studies ◽  
Invasive Procedures ◽  
Immature Brain

General anesthesia is necessary for patients to undergo surgery and invasive procedures. However, numerous preclinical studies have demonstrated widespread developmental neurotoxicity of the commonly used anesthetics and sedatives for the immature brain. Clinical studies also suggest a strong correlation between childhood anesthesia exposure and subsequent behavioral or cognitive impairment in adulthood. These findings have attracted increasing attention of anesthesiologists, pediatricians, and caregivers about the safety of anesthesia exposure in children, especially during early childhood. Herein, the aim of this review was to present the molecular mechanism of general anesthesia and its effects on the developing brain and introduce the recent clinical evidence of changes in cognition function post-childhood general anesthesia exposure. More importantly, some of the spots will be importantly discussed to scrutinize the phenomena; only in this way, it may help minimize or eliminate relevant risk factors.

Liraglutide for psychiatric disorders: clinical evidence and challenges

2018 ◽  
Vol 36 (2) ◽  
Author(s):  
Mehmet Akif Camkurt ◽  
Luca Lavagnino ◽  
Xiang Y. Zhang ◽  
Antonio L Teixeira
Keyword(s):  
Risk Factors ◽  
Psychiatric Disorders ◽  
Clinical Evidence ◽  
Preclinical Studies ◽  
Potential Candidate ◽  
Obesity And Diabetes ◽  
Treatment Of Diabetes ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Diabetes And Obesity

Abstract Obesity and diabetes are both risk factors and consequences of psychiatric disorders. Glucagon like peptide 1 (GLP-1) receptor agonists such as liraglutide are widely used in the treatment of diabetes and obesity. There are considerable amounts of preclinical studies showing the effects of liraglutide on promotion of neurogenesis, while preventing apoptosis and oxidation. Preliminary clinical evidence has suggested that liraglutide could decrease weight gain, improve cognition and prevent cognitive decline. Accordingly, liraglutide has been regarded as a potential candidate for the management of psychiatric disorders. Herein, we will discuss the association between obesity/diabetes and psychiatric disorders, and the emerging use of liraglutide in psychiatry.

scholarly journals The effects of anaesthesia on the developing brain: a summary of the clinical evidence

F1000Research ◽  
2013 ◽  
Vol 2 ◽  
pp. 166 ◽  
Author(s):  
Clara KY Yu ◽  
Vivian Man Ying Yuen ◽  
Gordon TC Wong ◽  
Michael G Irwin
Keyword(s):  
Adverse Effects ◽  
Human Brain ◽  
Clinical Studies ◽  
Detrimental Effect ◽  
Clinical Evidence ◽  
Learning Disorders ◽  
Invasive Procedures ◽  
Neurocognitive Assessment ◽  
Developmental Impairment ◽  
Research Questions

Introduction: There is data amassing in the literature regarding the potentially adverse effects of anaesthesia exposure on the developing human brain. The purpose of this article is to summarise current relevant data from clinical studies in this area. Methods: Articles from journals written in English were searched for using PubMed, Ovid and Medline. Keywords used included: brain (newborn, infant, child and neonate), neurodegeneration, apoptosis, toxicity, neurocognitive impairment (developmental impairment and learning disorders) and anaesthesia (intravenous, inhalational and sedation).Results: From the initial search, 23 articles were identified as potentially relevant, with publication dates spanning from 1978 to 2012.  Twelve studies were deemed irrelevant to the research questions. The results of neurocognitive assessment from eight of the remaining eleven studies had showed some differences in the performances of children exposed to anaesthesia. The control population in these studies was highly variable. The age at which the subjects were exposed to anaesthesia ranged from prenatal to 4 years in the majority of studies with one including children aged up to 12 years when exposed. Discussion: Although there is clinical data suggesting a possible detrimental effect, the evidence is best considered preliminary and inconclusive at this stage. Many of the outcome measures were lacking in specificity and standardization in most cases. Parents should be counselled to not avoid necessary invasive procedures for fear of a currently ill-defined risk.  However, deferral of elective procedures beyond the first few years of life should be contemplated.

scholarly journals Generalized data of criteria of risk factors for the use of the drug torasemide from the materials of its preclinical studies

2020 ◽  
Author(s):  
Natalia A. Anisimova ◽  
Natalia O. Selizarova ◽  
Grigory A. Plisko ◽  
Evgeny D. Semivelichenko ◽  
Svetlana M. Napalkova
Keyword(s):  
Risk Factors ◽  
Arterial Hypertension ◽  
Clinical Studies ◽  
Generic Drugs ◽  
Preclinical Studies ◽  
Efficacy And Safety ◽  
Cardiovascular Pathology ◽  
Pharmacological Studies ◽  
Search For Information ◽  
Preclinical And Clinical Studies

This study presents the review and analysis of materials, the summary of the data on the results of experimental (preclinical) pharmacological studies of the drug Torasemide and the results of clinical studies of the original drug Demadex, based on risk factors influencing the outcomes of hypertension in people. The information on the efficacy and safety of the drugs based on Torasemide is also presented in the relevant sections of the article. The search for information sources for the review was carried out using domestic and international databases elibrary and PubMed, applying contextual queries, including international non-proprietary names, terms of preclinical studies of pharmacokinetics, pharmacodynamics, and animal species used. This review considers the aspects of safety, pharmacokinetics, primary and secondary pharmacodynamics of Torasemide, available in various sources describing its preclinical studies. The summarized data presented in the study, in our opinion, may be used by researchers who are engaged in preclinical and clinical studies, as well as the issues of studying the efficacy and safety of generic drugs used in the treatment of patients with arterial hypertension and other cardiovascular pathology. The information on the advantages of Torasemide in comparison with Furosemide in the treatment of animals with simulated arterial hypertension deserves special consideration.

scholarly journals Mapping the preclinical to clinical evidence and development trajectory of the oncolytic virus talimogene laherparepvec (T-VEC): a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e029475 ◽  
Author(s):  
Manoj Lalu ◽  
Garvin J Leung ◽  
Yuan Yi Dong ◽  
Joshua Montroy ◽  
Claire Butler ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Studies ◽  
Clinical Evidence ◽  
Response Rate ◽  
Complete Response Rate ◽  
Complete Response ◽  
Risk Of Bias ◽  
Preclinical Studies ◽  
Talimogene Laherparepvec ◽  
Development Trajectory

ObjectiveThis study aimed to conduct a systematic review of preclinical and clinical evidence to chart the successful trajectory of talimogene laherparepvec (T-VEC) from the bench to the clinic.DesignThis study was a systematic review. The primary outcome of interest was the efficacy of treatment, determined by complete response. Abstract and full-text selection as well as data extraction were done by two independent reviewers. The Cochrane risk of bias tool was used to assess the risk of bias in studies.SettingEmbase, Embase Classic and OvidMedline were searched from inception until May 2016 to assess its development trajectory to approval in 2015.ParticipantsPreclinical and clinical controlled comparison studies, as well as observational studies.InterventionsT-VEC for the treatment of any malignancy.Results8852 records were screened and five preclinical (n=150 animals) and seven clinical studies (n=589 patients) were included. We saw large decreases in T-VEC’s efficacy as studies moved from the laboratory to patients, and as studies became more methodologically rigorous. Preclinical studies reported complete regression rates up to 100% for injected tumours and 80% for contralateral tumours, while the highest degree of efficacy seen in the clinical setting was a 24% complete response rate, with one study experiencing a complete response rate of 0%. We were unable to reliably assess safety due to the lack of reporting, as well as the heterogeneity seen in adverse event definitions. All preclinical studies had high or unclear risk of bias, and all clinical studies were at a high risk of bias in at least one domain.ConclusionsOur findings illustrate that even successful biotherapeutics may not demonstrate a clear translational road map. This emphasises the need to consider increasing rigour and transparency along the translational pathway.PROSPERO registration numberCRD42016043541.

scholarly journals The effects of anaesthesia on the developing brain: a summary of the clinical evidence

F1000Research ◽  
2013 ◽  
Vol 2 ◽  
pp. 166 ◽  
Author(s):  
Clara KY Yu ◽  
Vivian Man Ying Yuen ◽  
Gordon TC Wong ◽  
Michael G Irwin
Keyword(s):  
Adverse Effects ◽  
Human Brain ◽  
Clinical Studies ◽  
Detrimental Effect ◽  
Clinical Evidence ◽  
Learning Disorders ◽  
Invasive Procedures ◽  
Neurocognitive Assessment ◽  
Developmental Impairment ◽  
Research Questions

Introduction: There is data amassing in the literature regarding the potentially adverse effects of anaesthesia exposure on the developing human brain. The purpose of this article is to summarise current relevant data from clinical studies in this area. Methods: Articles from journals written in English were searched for using PubMed, Ovid and Medline. Keywords used included: brain (newborn, infant, child and neonate), neurodegeneration, apoptosis, toxicity, neurocognitive impairment (developmental impairment and learning disorders) and anaesthesia (intravenous, inhalational and sedation).Results: From the initial search, 23 articles were identified as potentially relevant, with publication dates spanning from 1978 to 2012.  Twelve studies were deemed irrelevant to the research questions. The results of neurocognitive assessment from eight of the remaining eleven studies had showed some differences in the performances of children exposed to anaesthesia. The control population in these studies was highly variable. The age at which the subjects were exposed to anaesthesia ranged from prenatal to 4 years in the majority of studies with one including children aged up to 12 years when exposed. Discussion: Although there is clinical data suggesting a possible detrimental effect, the evidence is best considered preliminary and inconclusive at this stage. Many of the outcome measures were lacking in specificity and standardization in most cases. Parents should be counselled to not avoid necessary invasive procedures for fear of a currently ill-defined risk.  However, deferral of elective procedures beyond the first few years of life should be contemplated.

Renin–angiotensin system as a potential therapeutic target in stroke and retinopathy: experimental and clinical evidence

2016 ◽  
Vol 130 (4) ◽  
pp. 221-238 ◽  
Author(s):  
Abdelrahman Y. Fouda ◽  
Sandeep Artham ◽  
Azza B. El-Remessy ◽  
Susan C. Fagan
Keyword(s):  
Traumatic Brain Injury ◽  
Cognitive Impairment ◽  
Brain Injury ◽  
Clinical Studies ◽  
Clinical Evidence ◽  
Renin Angiotensin System ◽  
Potential Therapeutic Target ◽  
Angiotensin System ◽  
Renin Angiotensin

This review examines the published literature on the role of the renin-angiotensin system in neurovascular disorders including stroke, retinopathy, traumatic brain injury and cognitive impairment. The review presents both experimental and clinical studies conducted in the field, and sheds light on the translational gap and clinical underutilization of renin-angiotensin system modulators in neurovascular disorders.

Crocus sativus L. (Saffron) in Alzheimer’s disease treatment: bioactive effects on cognitive impairment

2021 ◽  
Vol 19 ◽  
Author(s):  
Grazia D’Onofrio ◽  
Seyed Mohammad Nabavi ◽  
Daniele Sancarlo ◽  
Antonio Greco ◽  
Stefano Pieretti
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Clinical Studies ◽  
Clinical Status ◽  
Crocus Sativus ◽  
Preclinical Studies ◽  
Crocus Sativus L

: Crocus sativus L. (saffron) appears to own neuroprotective effects on cognitive impairment in patients with Alzheimer’s disease (AD). The purpose of this work is to review the evidence and mechanisms of saffron-induced therapeutic outcomes and measureable cognitive benefits in AD. The literature was reviewed, and preclinical and clinical studies were identified. In vitro and in vivo preclinical studies were selected according to these criteria: 1) development of saffron pharmacological profile on biological or biophysical endpoints; 2) evaluation of saffron efficacy using animal screens as an AD model, and 3) duration of the studies of at least 3 months. As for the clinical studies, the selection criteria included: 1) patients aged ≥ 60, 2) AD diagnosis according to National Institute on Aging-Alzheimer's Association (NIAAA) criteria, and 3) appropriate procedures to assess cognitive, functional, and clinical status. A total of 1477 studies published until November 2020 were identified during an initial phase, of which 24 met the inclusion criteria and were selected for this review. Seventeen in vitro and in vivo preclinical studies have described the efficacy of saffron on cognitive impairment in animal models of AD, highlighting that crocin appears to be able to regulate glutamate levels, reduce oxidative stress, and modulate Aβ and tau protein aggregation. Only four clinical studies have indicated that the effects of saffron on cognitive impairment were not different from those produced by donepezil and memantine and that it had a better safety profile. Saffron and its compounds should be further investigated in order to consider them a safer alternative in AD treatment.

Physical activity and cognitive function in older persons

2016 ◽  
Vol 64 (2) ◽  
Keyword(s):  
Physical Activity ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Executive Functions ◽  
Cognitive Aging ◽  
Clinical Studies ◽  
Older Persons ◽  
Positive Effects ◽  
Critical Challenge

Strategies to improve cognitive aging are highly needed. Among those, promotion of exercise and physical activity appears as one of the most attractive and beneficial intervention. Indeed, results from basic and clinical studies suggest that exercise and physical activity have positive effects on cognition in older persons without cognitive impairment, as well as in those with dementia. Despite inconsistent results, aerobic exercise appears to have the strongest potential to enhance cognition. However, even limited periods of walking (45 minutes, three times a week, over a 6-month period) have also been shown to enhance cognition, particularly executive functions. Changing long-term lifestyle habits in these older persons remains a critical challenge and attractive programs susceptible to gain adherence are needed to succeed in achieving improved cognitive aging.

Elucidating the risk factors for progression from amyloid-negative amnestic mild cognitive impairment to dementia

2020 ◽  
Vol 17 ◽  
Author(s):  
Hyung-Ji Kim ◽  
Jae-Hong Lee ◽  
E-nae Cheong ◽  
Sung-Eun Chung ◽  
Sungyang Jo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Amnestic Mild Cognitive Impairment ◽  
Amyloid Pet ◽  
Clinical Progression ◽  
Amnestic Mci

Background: Amyloid PET allows for the assessment of amyloid β status in the brain, distinguishing true Alzheimer’s disease from Alzheimer’s disease-mimicking conditions. Around 15–20% of patients with clinically probable Alzheimer’s disease have been found to have no significant Alzheimer’s pathology on amyloid PET. However, a limited number of studies had been conducted this subpopulation in terms of clinical progression. Objective: We investigated the risk factors that could affect the progression to dementia in patients with amyloid-negative amnestic mild cognitive impairment (MCI). Methods: This study was a single-institutional, retrospective cohort study of patients over the age of 50 with amyloidnegative amnestic MCI who visited the memory clinic of Asan Medical Center with a follow-up period of more than 36 months. All participants underwent brain magnetic resonance imaging (MRI), detailed neuropsychological testing, and fluorine-18[F18]-florbetaben amyloid PET. Results: During the follow-up period, 39 of 107 patients progressed to dementia from amnestic MCI. In comparison with the stationary group, the progressed group had a more severe impairment in verbal and visual episodic memory function and hippocampal atrophy, which showed an Alzheimer’s disease-like pattern despite the lack of evidence for significant Alzheimer’s disease pathology. Voxel-based morphometric MRI analysis revealed that the progressed group had a reduced gray matter volume in the bilateral cerebellar cortices, right temporal cortex, and bilateral insular cortices. Conclusion: Considering the lack of evidence of amyloid pathology, clinical progression of these subpopulation may be caused by other neuropathologies such as TDP-43, abnormal tau or alpha synuclein that lead to neurodegeneration independent of amyloid-driven pathway. Further prospective studies incorporating biomarkers of Alzheimer’s diseasemimicking dementia are warranted.

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