With advances in health care and increased life expectancy, the population of older adults is increasing in most countries. Japan has been considered a “super-aged society” since 2007. It is predicted that by 2030, Japan’s aging rate will rise to 31.6%, indicating that one-third of Japanese people will be a senior citizen aged 65 years or older.
Advancing age is the strongest risk factor for the development of dementia and dementia has been identified as a major current health care challenge. It is expected that the number of elderly people with dementia will exceed 8 million by 2030. Considering these facts, it is reasonable to expect that the number of dementia patients undergoing oral surgery will rapidly increase.
There are many different forms of dementia. Alzheimer’s disease is the most common form of dementia and may contribute to more than 50% of cases. Dementia patients show diverse symptoms, which are classified into two categories, core symptoms and behavioral and psychological symptoms of dementia (BPSD). Core symptoms are caused by loss of neuron in the brain. The pathogenesis of BPSD is complex and multifactorial and probably the result of a complex interplay of psychological, social, environmental, and biological factors.
Preoperative assessment regarding cognitive and functional status and the presence of preoperative delirium is essential in geriatric patients. Cognitive dysfunction is relatively common during the postoperative course of older adults. Two neurocognitive syndromes that have been studied in relation to surgery and anesthesia are postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), both of which occur more commonly in older adults after surgery and anesthesia. POD has been defined as an acute change in cognitive status characterized by fluctuating attention and consciousness, which typically occurs soon after surgery, while POCD is characterized by more persistent cognitive difficulties, including memory and attention problems, as well as executive dysfunction, and occurs commonly after surgery. It has been demonstrated in some in vitro, animal, and human studies that some anesthetics are associated with increased risk of cognitive dysfunction.
The aim of this review is to identify an evidence-based perioperative management for patients with dementia that are scheduled to undergo oral surgery. This review also reflects on both general considerations concerning geriatric patients with dementia and on the specific features of perioperatively used drugs and anesthetics that might have an impact on patients with cognitive dysfunction.
Oral surgeon and dental anesthesiologists should be fully aware of the systemic management in patients with dementia. The risks and benefits associated with surgery and anesthesia need to be well-considered.