Metabolic Interventions for Sleep, Anesthesia-related Neurocognitive Disorders and Alzheimer's Disease

摘要 这项研究的目的是开发代谢干预措施，以改善睡眠质量， 老年人的麻醉安全性，并最终用于治疗神经退行性疾病，如阿尔茨海默病。 衰老的大脑有许多变化，包括线粒体功能障碍，胰岛素抵抗和减少 神经递质释放导致睡眠质量差和全身麻醉的更多并发症。的 大脑使用葡萄糖的能力随着年龄的增长而下降，但大脑使用酮作为燃料的能力仍然存在。酮 脂肪酸分解后自然生成，成为大脑的主要燃料来源 在饥饿、运动和高脂肪、低碳水化合物饮食的时候。酮体乙酰乙酸酯和 β-羟基丁酸不仅为大脑提供能量，还具有强有力的信号传导和抗炎作用。 方面的影响.炎症途径的激活，如核因子κ B，被认为是一个 睡眠障碍和痴呆症以及术后谵妄和痴呆症之间的联系机制 术后认知功能障碍炎症反应也与发病密切相关， 阿尔茨海默病的临床过程和睡眠中断是阿尔茨海默病的早期生物标志物。 睡眠质量也随着正常年龄的增长而下降，失去了恢复性的缓慢和三角洲力量， 支离破碎。因此，通过提供酮来靶向大脑能量使用可能是改善大脑能量消耗的一种策略。 老年动物的睡眠质量此外，老年人群更容易接受全身麻醉。少 麻醉老年人需要麻醉，他们更有可能发展术后认知功能 功能障碍酮的能量底物和抗炎作用可能在治疗期间具有神经保护作用 老年大脑的麻醉总之，这些想法产生了新的战略，解决 通过增加酮，可能导致老年大脑中功能失调的神经元代谢-免疫相互作用， 改善老年人的睡眠质量（AIM 1）和更安全的全身麻醉（AIM 2）。这些创新 改善老年人大脑健康的战略有可能产生广泛的影响， 包括癫痫、阿尔茨海默病、帕金森病在内的代谢失调疾病 疾病、自闭症、焦虑、抑郁和胶质母细胞瘤。

ABSTRACT This objective of this research is to develop metabolic interventions to improve sleep quality and anesthesia safety in the elderly and eventually to treat neurodegenerative diseases like Alzheimer's disease. The aging brain has many changes including mitochondrial dysfunction, insulin resistance and decreased neurotransmitter release leading to poor sleep quality and more complications with general anesthesia. The ability of the brain to use glucose declines with age but the brain's ability to use ketones as fuel remains. Ketone bodies are produced naturally from the breakdown of fatty acids and become a major fuel source for the brain during times of starvation, exercise and high-fat, low-carbohydrate diets. The ketone bodies acetoacetate and beta-hydroxybutyrate not only provide energy to the brain but also have potent signaling and anti-inflammatory effects. The activation of inflammatory pathways, such as nuclear factor kappa B, are thought to be one mechanism through which sleep disturbance and dementia are linked as well as post-operative delirium and post-operative cognitive dysfunction. The inflammatory response is also tightly correlated with the onset and clinical course of Alzheimer's disease and disruptions in sleep are an early biomarker of Alzheimer's disease. Sleep quality declines with normal age as well, losing restorative slow and delta power and becoming more fragmented. Therefore, targeting brain energy usage by providing ketones could be one strategy for improving sleep quality in aged animals. In addition, the aged population is more susceptible to general anesthesia. Less anesthesia is needed to anesthetize older people and they are more likely to develop post-operative cognitive dysfunction. The energy substrate and anti-inflammatory effects of ketones could be neuroprotective during anesthesia in the aged brain. Taken together, these ideas give rise to novel strategies that address the dysfunctional neuronal metabolic-immune interactions in the aged brain by increasing ketones that could lead to improved sleep quality (AIM 1) and safer delivery of general anesthesia (AIM 2) to the elderly. These innovative strategies to improve brain health in the aged population have the potential for broad impact as many brain diseases have components of metabolic dysregulation including epilepsy, Alzheimer's disease, Parkinson's disease, autism, anxiety, depression and glioblastoma.