By Dr. Kenneth Kim, Board-Certified Plastic Surgeon, Los Angeles, CA

 

The increasing prevalence of dementia is a phenomenon capturing the attention of healthcare professionals and the general public alike. Characterized by a decline in memory, thinking, and problem-solving abilities, dementia is becoming more common, posing significant challenges to individuals and society. As a seasoned medical expert, I have observed how various factors, ranging from medical interventions to lifestyle choices, can influence our cognitive health.

 

According to Alzheimer’s Disease International, there were 55 million reported cases of dementia in 2020, with an expectation to double in 20 years. This surge in dementia cases is a call to deepen our understanding of cognitive health and the everyday choices that shape it. 

 

Let’s explore these critical factors to gain a clearer understanding of the challenges and potential strategies for maintaining cognitive well-being in our modern world.

 

General anesthesia and its potential impact on cognitive health

General anesthesia — a critical component in modern surgical practice — ensures pain-free and unconscious experiences during medical procedures. Its role is indispensable, yet it brings forth questions about its potential long-term effects on cognitive health, especially concerning dementia.

 

General anesthesia induces a reversible state characterized by unconsciousness, analgesia (pain relief), and muscle relaxation. Achieved through drugs that act on the brain and nervous system, anesthesia alters neurotransmitter levels, the chemicals key to nerve cell communication. While necessary for its intended effect, this disruption might have residual impacts on cognitive functions, particularly in individuals with certain vulnerabilities.

 

There’s also a concern regarding the potential of some anesthetics to trigger inflammatory responses in the brain, which play a significant role in numerous neurological conditions and could potentially accelerate degenerative processes leading to cognitive decline. Moreover, anesthesia might affect the brain’s waste removal system — the glymphatic system — thereby impairing its efficiency and potentially leading to the accumulation of dementia-related proteins like beta-amyloid.

 

The relationship between general anesthesia and dementia remains a topic of active investigation. While recognizing the indispensable role of anesthesia in surgery, it’s equally important to understand its possible long-term implications on brain health. This knowledge helps balance the immediate benefits of anesthesia with considerations for its potential impact on cognitive health, especially in vulnerable populations.

 

Risks associated with certain medications

The connection between certain medications and cognitive health has become a subject of increasing scrutiny in medical research. Specifically, the prolonged use of anti-anxiety medications — such as benzodiazepines and sleep medications (including sedative-hypnotics) — has been associated with an elevated risk of cognitive impairment and dementia.

 

Benzodiazepines and sedative-hypnotics are commonly prescribed for anxiety and sleep disorders. They work by altering the activity of neurotransmitters in the brain, which helps to induce a calming or sedative effect. While effective for short-term relief, their long-term use raises concerns. Studies have shown that prolonged exposure to these medications can lead to changes in brain function, which is particularly worrying as these drugs are often used by older adults, who are already at higher risk for cognitive decline.

 

The risk associated with these medications is believed to be linked to their impact on neurotransmitter systems over time, since they primarily target the neurotransmitter gamma-aminobutyric acid (GABA), enhancing its effects. GABA is crucial for regulating neuronal excitability throughout the nervous system. Prolonged use of medications that amplify GABA’s effects can potentially lead to a downregulation of GABA receptors, making neurons less responsive. This altered neural activity could contribute to cognitive decline and an increased risk of developing dementia.

 

Unhealthy lifestyle choices and dementia risk

The connection between lifestyle choices and the risk of dementia is increasingly recognized in medical research. Lifestyle factors such as diet, exercise, smoking, alcohol consumption, and sleep patterns play a crucial role in an individual’s overall cognitive health.

 

• Diet and cognitive health: Diets high in processed foods, sugars, and unhealthy fats have been linked to a higher risk of cognitive decline. Conversely, diets rich in vegetables, fruits, whole grains, and healthy fats, like the Mediterranean diet, are associated with a reduced risk of dementia. These foods provide essential nutrients and antioxidants that support brain function and reduce inflammation, a key factor in cognitive disorders.

 

• Physical exercise and brain function: Exercise not only improves physical health but also has a significant positive impact on brain health. It enhances blood flow to the brain, supports the growth of new brain cells, and aids in maintaining existing neural networks. 

 

• Smoking, alcohol, and cognitive decline: Smoking can lead to vascular disorders that reduce blood flow to the brain, increasing the risk of dementia. Similarly, heavy alcohol use has been linked to an increased risk of dementia, as it can cause neurotoxic effects on the brain. 

 

• The importance of sleep: During sleep, the brain removes toxins that accumulate during waking hours. Poor sleep patterns or disorders like sleep apnea can disrupt this process, leading to an accumulation of harmful proteins associated with dementia, such as beta-amyloid.

The consequences of poor health condition management

Effective management of chronic health conditions is critical in reducing the risk of dementia. Conditions like Type 2 diabetes, hypertension, and heart disease, when poorly managed, significantly increase the likelihood of cognitive decline. In diabetes, high blood sugar levels can damage blood vessels, impairing blood flow to the brain and contributing to vascular dementia. Insulin resistance, a feature of Type 2 diabetes, is also linked to decreased brain function and the accumulation of dementia-related proteins.

 

Hypertension is another major risk factor. Persistent high blood pressure can harm cerebral blood vessels, leading to reduced blood flow and an increased risk of strokes, which are closely associated with dementia. Similarly, heart health is directly linked to brain health. Heart diseases can lead to strokes or brain infarcts, contributing to cognitive decline.

 

The interplay between these chronic conditions and dementia highlights the importance of their effective management. Regular medical check-ups, adherence to treatments, and lifestyle changes are essential in mitigating dementia risk. By managing these health issues proactively, we can significantly reduce the likelihood of cognitive deterioration and improve overall brain health.

 

Addressing the factors related to an increase in dementia involves not just individual actions but also broader awareness and supportive environments for healthy choices and effective health management. Healthcare systems and professionals play a vital role in ongoing research and education, while individuals should be proactive in informed health decision-making.

 

We aim to foster a society with reduced dementia risks, promoting better cognitive health for all. A comprehensive strategy that includes both medical and lifestyle changes is key. Such an approach promises a future with lower dementia prevalence, enhancing the quality of life for individuals and communities alike.

 

— Dr. Kenneth Kim is a board-certified plastic and reconstructive surgeon practicing in Los Angeles. Dr. Kim was nominated for the Rhodes Scholarship and selected as a University Medal finalist at UC Berkeley. Dr. Kim graduated from Yale University School of Medicine and was a recipient of the Dean’s Award and Department of Surgery Research Award. Dr. Kim was inducted as a fellow at the Howard Hughes Medical Institute. He completed his plastic and reconstructive surgery residency at Northwestern University. Dr. Kim was awarded the AO Craniomaxillofacial Research and Development Fellowship at the AO Institute in Switzerland. He is an assistant clinical professor at UCLA School of Medicine, a partner of Dream Medical Group in Seoul, South Korea, and a clinical faculty at Seoul National University. He has published numerous peer-reviewed journals and serves as a reviewer for multiple surgical journals. Dr. Kim lectures at national and international plastic surgery conferences on the dangers of general anesthesia, especially how it affects memory. Dr. Kim believes in the importance of performing awake surgery without changing patients’ physiology to provide the safest surgery possible. He is a pioneer and a leading expert in awake plastic surgery. Dr. Kim focuses on eyelid, facelift, rhinoplasty, and breast surgeries.