A team of University of Virginia scientists has identified why a common type of delirium that often affects older patients after surgery may lead to dementia, and they’ve proposed a new treatment.
Dr. Nadia Lunardi, a neuro- and critical care anesthesiologist, traces her interest in protecting the aging brain to her medical residency in anesthesiology and intensive care medicine in Italy. (Contributed photo)
In a new study, Dr. Nadia Lunardi, a UVA associate professor of anesthesiology, and her colleagues found anesthesia, surgery and the stress of intensive care disrupted the cognitive health of older mice.
They also found that vorinostat, an FDA-approved cancer drug, can reverse some of these harmful effects.
Lunardi spoke with UVA Today about the findings and her work at UVA Health.
Q. How would you describe your research?
A. Our work focuses on what we call post-surgery delirium, which is a sudden loss of cognition that can occur in older adults after surgery. We are trying to understand how the combination of anesthesia, surgery, sleep disruption and other stresses of hospitalization affects the aging brain and contributes to this condition.
Up until 10 years ago or so, we thought this condition was relatively uncommon and that it would resolve on its own. But there’s been a lot of research since then, and we now realize that this sudden loss of cognition is actually very frequent, particularly as the age of our surgical population continues to grow.
We’re able to perform surgery on older patients, thanks to many advancements in medicine, but we’re also realizing that the aging brain can be particularly vulnerable. When these patients are exposed to stressors such as anesthesia, surgery and the ICU environment, those stressors can trigger changes in the brain that lead to delirium. As more research goes into this, we’re finding that in some individuals, these changes don’t simply resolve after surgery is over. Instead, they can be associated with persistent cognitive impairment that lasts for months, and sometimes even years, after the original hospitalization.
Q. What did you find out about the potential benefits of vorinostat for these patients?
A. We have demonstrated, both in a mouse model and in tissue from patients who develop delirium after surgery, that a drug already FDA-approved for use in certain types of cancer can improve some of the deficits associated with delirium. Specifically, it reduces some of the cognitive and sleep impairments associated with this acute syndrome. Next, we’re hopeful we can expand upon these preliminary data and test whether some of these findings hold true in clinical studies.
Q. In addition to being an associate professor of anesthesiology, what else are you involved with at UVA?
A. I serve as the neuroanesthesia division chief and work in the operating rooms, providing anesthesia for brain and spine surgeries. We do many complex brain and spine surgeries here at UVA, including procedures to reconstruct multiple levels of the spine. I lead a team of eight neuroanesthesiologists, who work alongside me and our excellent neurosurgery and orthopedic colleagues to provide dedicated, specialized care for these patients.
I also spend time in the intensive care unit. I completed a critical care fellowship and obtained a Ph.D. in pharmacology and toxicology. I consider myself very fortunate to be able to take care of some of these patients when they are admitted to the intensive care unit after surgery. It gives me the opportunity to follow patients beyond the operating room and develop relationships with them and their families during what can be a very challenging time.
