Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Les nouveaux neurones de l’hippocampe semblent contribuer à l’action thérapeutique des antidépresseurs. La nature fonctionnelle de cette contribution est cependant inconnue. En stimulant la neurogenèse les antidépresseurs pourraient renforcer certaines fonctions de l’hippocampe et ainsi permettre la rémission. Nous montrons dans ce travail que les nouveaux neurones peuvent contribuer à l’action thérapeutique des antidépresseurs en participant au renforcement de rétrocontrôle hippocampique sur la régulation de l’axe HPA, potentiellement via leur rôle dans la capacité de l’hippocampe à moduler l’activité des autres structures impliquées dans la régulation du stress, comme le noyau du lit de la strie terminale. Les différentes composantes fonctionnelles de l’hippocampe sont cependant topographiquement distribuées le long de son axe septo-temporal. A travers une approche corrélative nous avons montré que différents antidépresseurs régulent la neurogenèse différentiellement le long de l’axe septo-temporal. Cela suggère des mécanismes de régulation régiondépendants et que la contribution des nouveaux neurones dans les effets des antidépresseurs pourrait être multiple et sous tendue par des composantes fonctionnelles différentes, et non limitée à la régulation de l’axe du stress. / Hippocampal newborn neurons contribute to some extent to the therapeutic effects of antidepressants. Mechanisms involved in this contribution remain however elusive. By increasing the recruitment of newborn neurons antidepressants could improve several hippocampal functions and thus allow remission. Here we demonstrate that newborn neurons may contribute to the therapeutic effects of antidepressants by allowing the recovery of a proper hippocampal inhibitory feedback over the HPA axis, possibly by normalizing the communication between the hippocampus and stress integrative structures mediating its inhibitory influence, such as the bed nucleus of the stria terminalis. Hippocampal functions are however topographically segregated along its septo-temporal axis. Here we show that different mood-improving manipulations differentially regulate neurogenesis along this septo-temporal axis. This suggest different region-specific mechanisms involved in the regulation of neurogenesis and that newborn neurons may contribute to the therapeutic effects of antidepressants by modulating different aspects of hippocampal functions.

Les traitements des pathologies de l’oreille interne par voie locale se développent en alternative aux traitements par voie générale peu efficaces et responsables de nombreux effets secondaires. Dans ce travail, nous avons développé une formulation originale constituée de liposomes dispersés au sein d’un gel d’acide hyaluronique pour la libération prolongée d’un corticoïde dans l’oreille interne après administration locale dans l’oreille moyenne. D'abord, une étude physicochimique approfondie a permis d'identifier les paramètres clés de formulation qui ont un impact sur les propriétés du gel de liposomes en termes de caractéristiques rhéologiques, de seringabilité, de stabilité, de microstructure et enfin de diffusion des liposomes dans le gel. Ensuite, le gel de liposomes contenant la dexamethsone phosphate a été évalué in vivo chez le cobaye. L'administration locale du gel de liposomes a abouti à une libération prolongée du corticoïde dans l'oreille interne, sans aucun effet négatif sur la fonction auditive. L’évaluation de l’efficacité thérapeutique de la formulation pour le traitement de la surdité secondaire à un traumatisme sonore et pour la préservation de l’audition durant l’implantation cochléaire a montré des résultats préliminaires très prometteurs. / Local, rather than systemic drug delivery is being developed to treat inner ear diseases. In this work, we developed an original drug delivery system based on liposomes dispersed within a hyaluronic acid gel for the sustained delivery of a corticoid to the inner ear after local administration in the middle ear. First, a thorough physicochemical study allowed to identify the key formulation parameters that impact the liposomal gel properties in terms of rheological behavior, syringeability, stability, microstructure and diffusion of liposomes within the gel. Then, the liposomal gel containing dexamethsone phosphate was evaluated in vivo in guinea pig. The local administration of the liposomal gel in the middle ear resulted in a sustained release of the corticoid in the inner ear without any negative effect on the hearing function. Promising preliminary data were obtained regarding the therapeutic efficacy of the formulation for hearing recovery after acoustic trauma and for hearing preservation during cochlear implantation.

Der niedrig dosierte Dexamethason-Suppressionstest (LDDST) wird als Screeningverfahren in der Diagnostik des Cushing-Syndroms angewendet. Allerdings können Faktoren wie die variable Resorption, sowie ein gesteigerter Metabolismus von Dexamethason die Testergebnisse beeinflussen und zu falsch positiven Resultaten führen. Ein falsch positives Testresultat wird hierbei insbesondere bei adipösen Patienten häufiger beobachtet. In der vorliegenden Arbeit wurde daher der Einfluss des Körpergewichts auf das Ergebnis des Dexamethason-Suppressionstestes (DST) untersucht. Hierzu wurden hospitalisierte Patienten und ein aus gesunden Probanden bestehendes Kontrollkollektiv rekrutiert und diese einem regulären LDDST unterzogen. Es konnte gezeigt werden, dass übergewichtige Menschen im Rahmen des DST signifikant niedrigere Dexamethasonwerte erreichen als normalgewichtige Personen. Es ist daher davon auszugehen, dass Unterschiede im Body-Mass-Index (BMI) Einfluss auf die Resorptionsrate und den Metabolismus von Dexamethason nehmen und daraus resultierend die Serum-Dexamethasonspiegel wesentlich verringern können. Diese Prozesse scheinen allerdings keinen nachhaltigen Einfluss auf die Cortisolsuppression im DST zu haben, da die Cortisolwerte nach Dexamethasongabe zwischen adipösen und nicht adipösen Testpersonen nicht signifikant differierten. Diese Ergebnisse belegen, dass ein Zusammenhang zwischen BMI-Unterschieden und der Dexamethasonkinetik im LDDST besteht. Die erniedrigten Dexamethasonspiegel bei übergewichtigen Patienten scheinen hierbei insbesondere durch das wesentlich höhere Verteilungsvolumen und durch Unterschiede im hepatogenen Metabolismus bedingt zu sein. Trotz der erniedrigten Dexamethasonwerte bleibt die Feed-Back-Sensitivität der Hypothalamus-Hypophysen-Nebennieren-Achse (HHNA) auch bei Adipositas erhalten, weshalb der LDDST als zuverlässiges Screeningverfahren bei adipösen Patienten mit Verdacht auf Cushing-Syndrom einzustufen ist.

Thesis (MSc (Biochemistry))--Stellenbosch University, 2008. / Gonadotropin-releasing hormone (GnRH) acting through the cognate GnRH receptor (GnRH-R) plays an important role in the regulation of mammalian reproductive function by regulating the synthesis and release of follicle stimulating hormone (FSH) and luteinizing hormone (LH). The sensitivity of pituitary gonadotropes to GnRH depends on the number of GnRH receptors present on the gonadotrope cell surface. GnRH-R is regulated at a transcriptional, post-transcriptional and post-translational level. Hormones such as GnRH and glucocorticoids (GCs) regulate GnRH-Rs in a time- and dose-dependent manner. Previous studies have shown that the GnRH-R promoter confers glucocorticoid-dependent activation via the activating protein 1 (AP-1) site in the nongonadotrope GGH3 cell line. The mechanism by which GCs regulate the GnRH-R promoter is not precisely known as the literature is contradictory. Therefore this study investigates the mechanism of transcriptional regulation of the mouse GnRH-R promoter in the mouse gonadotrope cell line LβT2, treated with the synthetic GC dexamethasone (dex). Assays used include promoter-reporter studies, Western blotting, endogenous mRNA expression studies, electrophoretic mobility shift assay (EMSA) as well as the in vivo chromatin immunoprecipitation (ChIP) assay. A transfected promoter-reporter plasmid containing 600 bp of the mouse GnRH-R promoter was used to investigate the effect of dex on transcriptional regulation. Previously it was determined in our laboratory that the GnRH-R promoter is activated via an AP-1 binding site in the LβT2 cell line, and is regulated in a time- and dose-dependent manner by dex. In the present study in the LβT2 cell line a small induction was indeed seen upon dex treatment. Cotransfecting a expression vector for rat GR succeeded in inducing a 2 fold positive dex response. Western blot analysis revealed that GR levels remain consistent even after 8 hours dex induction. The effect of dex on the endogenous GnRH-R gene was investigated by means of real-time RT-PCR. Dex did indeed upregulate the gene in a time-dependant manner. Maximal induction (7.4 fold) was obtained after at least 12 hours of dex treatment. Untreated LβT2 nuclear extracts were investigated using EMSA, for protein binding to the mouse GnRH-R promoter AP-1 binding site, and these proteins were identified as c- Fos and GR. This suggests that the GR interacts with the AP-1 transcription factor via a tethering mechanism to mediate the positive dex response. The results of an in vivo ChIP assay were consistent with this hypothesis, showing that the GR interacted with a genomic fragment containingthe AP-1 site, in response to dex. The transactivation of the GnRH-R promoter by means of the GR tethering to AP-1 has not been shown before in the LβT2 cell line.

Glucocorticoids (GCs) are frequently prescribed pharmacological agents most notably for their immunosuppressant effects. Endogenous GCs mediate biological processes such as energy metabolism and tissue development. At the cellular level, GCs bind to the Glucocorticoid Receptor (GR), a cytosolic receptor that translocates to the nuclei upon ligand binding and alters gene transcription. Among a long list of genes activated by GCs is the Glucocorticoid Induced Leucine Zipper (GILZ). Although GC induced GILZ expression has been well established in lymphocytes, little is known whether cardiomyocytes respond to GCs by inducing GILZ. Unlike lymphocytes, in which GCs induce apoptosis and GILZ mediates GC induced apoptosis, cardiomyocytes respond to GCs by gaining resistance against apoptosis. We determined GILZ expression pattern in cardiomyocytes in vivo and in vitro. Our data demonstrate GILZ induction in cardiomyocytes both in vivo and in vitro by GCs and point to H9C2 cell line as a valid model for studying the biological function of GILZ in cardiomyocytes. I have also determined GILZ functions as GC induced cytoprotective protein against the known cardiac toxicant Doxorubicin. Finally I have determined GILZ stabilizes Bcl-xL pro-survival protein, providing a possible mechanism of cytoprotection in cardiomyocytes.

No description available.

O músculo estriado esquelético é uma entidade extremamente versátil, capaz de alterar seus padrões e características fenotípicas sob diversas condições, tais como, atividade neuromuscular, estimulação elétrica, idade, atividade hormonal e exercício físico. Sabe-se também que o balanço entre estímulos atróficos e hipertróficos controlam diretamente a massa muscular do indivíduo e estas variações implicam diretamente não apenas sobre o volume muscular, mas também conteúdo de proteínas e produção de força. Neste sentido, a atrofia muscular (perda de massa muscular) é caracterizada tanto pela diminuição na área de secção transversa das fibras musculares, como também pelo decréscimo no conteúdo de proteínas miofibrilares e consequente redução do volume muscular. Esta atrofia muscular pode ocorrer sob diversas condições clinicas e/ou patológicas, acarretando na diminuição ou perda da massa magra levando à uma consequente diminuição da atividade física, da qualidade de vida e inclusive pior resposta ao tratamento, ocasionando consequentemente aumento da mortalidade. Fica claro desta maneira, que, os métodos que visam a prevenção ou tratamento à atrofia muscular tem importante relevância clínica em muitos grupos de pacientes, além de ser um importante fator contribuinte na qualidade de vida e autonomia destes indivíduos. Com isso o estudo de determinados tratamentos que combatam a atrofia muscular torna-se de vital importância, dentre os quais, vem ganhando destaque o &#x3B2;Hidroxi &#x3B2;Metilbutirato (HMB). Deste modo teve-se como objetivo neste trabalho verificar a efetividade do HMB em prevenir a atrofia muscular induzida por dexametasona (DEXA). Para isto, foram utilizados 32 animais da linhagem Wistar com idade de 60 dias, distribuídos nos seguintes grupos: Grupo Experimental Placebo (GEP), n=8, tratados por 10 dias consecutivos com gavagem e injeção intraperitoneal, ambas contendo apenas solução salina; Grupo Experimental Dexametasona (GED), n=8, tratados por 10 dias consecutivos com gavagem contendo solução salina e injeção intraperitoneal contendo dexametasona; Grupo Experimental HMB (GEH), n=8, tratados por 10 dias consecutivos com gavagem contendo HMB e injeção intraperitoneal contendo solução salina; e Grupo Experimental Dexametasona + HMB (GEDH), n=8, tratados por 10 dias consecutivos com gavagem contendo HMB e injeção intraperitoneal contendo DEXA. Os animais foram acondicionados em caixas coletivas com 4 animais por caixa, com comida e agua à vontade em sala climatizada com temperatura de 22o e respeitando o ciclo de 12 horas claro/escuro. Finalizados os dez dias de tratamento, os animais foram eutanasiados para a coleta do material. Após as análises, as médias dos grupos para peso corpóreo dos animais, peso muscular e os valores da morfometria foram todos submetidos ao teste One-Way ANOVA, seguidos do Teste de Tukey, sendo o valor considerado estatisticamente significante de p<0,05. Ao final pôde-se concluir que, no delineamento experimental aqui aplicado, o HMB não foi capaz de atenuar ou prevenir a perda de peso corporal induzida pela DEXA, sendo que o efeito anticatabólico esperado pelo HMB não repercutiu no musculo EDL, contudo foi capaz de prevenir a atrofia no musculo sóleo. / The skeletal muscle is an extremely versatile entity, able to change their patterns and phenotypic characteristics under various conditions such as neuromuscular activity, electrical stimulation, age, hormonal activity and exercise. It is also known that the balance between atrophic and hypertrophic stimuli directly control the muscle mass of the individual and these changes directly affect not only on muscle volume, but also protein content and production strength. In this sense, muscle atrophy (loss of muscle mass) characterized by both, the decrease in cross-sectional area of muscle fibers, but also by decreasing the content of myofibrillar proteins and consequent reduction in muscle volume. This muscle atrophy may occur in various pathological conditions, resulting in decrease or loss of lean body mass leading to a consequent reduction in physical function, quality of life and even worse response to treatment, thus leading to increased mortality. It is clear in that way that the methods aimed at preventing or treating muscle atrophy has important clinical relevance in many groups of patients, as well as being a major contributing factor in the quality of life and autonomy of individuals. Thus, the study of certain treatments that combat muscle atrophy become of vital importance, among which highlight is winning the &#x3B2;-hydroxy-&#x3B2;-methylbutyrate (HMB). Thus, it is aimed in this study to assess the effectiveness of HMB to prevent muscle atrophy induced by dexamethasone (DEXA). For this, we used 32 Wistar animals aged 60 days, distributed in the following groups: experimental group Placebo (GEP), n = 8, treated for 10 consecutive days with gavage and intraperitoneal injection, both containing only saline. Experimental group Dexamethasone (GED), n = 8, treated for 10 consecutive days with gavage containing saline and intraperitoneal injection containing dexamethasone. Experimental group HMB (GEH), n = 8, treated for 10 consecutive days with gavage containing HMB and intraperitoneal injection containing saline solution and Experimental Group Dexamethasone + HMB (GEDH), n = 8, treated for 10 consecutive days with gavage containing HMB and intraperitoneal injection containing DEXA. The animals were placed in collective boxes with 4 animals per cage with food and water at will in a room with 22o temperature and respecting the light / dark 12-hour cycle. Completed the ten days of treatment, the animals were euthanized to collect the material. After the analysis, the mean body weight to groups of animals, muscle weight and values of morphometry were all subjected to one-way ANOVA followed by Tukey test, with the amount considered statistically significant at p <0.05. At the end, it could be concluded that the experimental design applied here, the HMB was not able to mitigate or prevent the loss of body weight induced by DEXA, and the anti-catabolic effect expected by HMB not reflected in the EDL muscle, but was able to prevent atrophy in the soleus muscle.

A inflamação é uma resposta protetora para livrar o organismo da causa inicial da lesão celular e suas consequências, porem se excessiva e não modulada, pode provocar a destruição progressiva do tecido. Este estudo pretende contribuir para o esclarecimento da influência de dois anti-inflamatórios, a dexametasona e o diclofenaco sódico, sobre a fase inflamatória do processo reparativo tecidual, bem como sobre o número de mastócitos nas diferentes fases do reparo. Foram utilizadas 60 ratas Wistar, divididas em 3 grupos (1, 2 e 3), medicadas 30 minutos antes de uma intervenção cirúrgica (lesão de 3mm de diâmetro no ventre lingual), com injeção intramuscular de 0,235mg/kg de dexametasona; 4,45mg/kg de diclofenaco sódico ou solução salina estéril, respectivamente. Os 3 grupos foram subdivididos em a, b, c, d, de acordo com o tempo de sacrifício: 6, 24, 48 e 120 horas após a cirurgia. As lesões foram fotografadas logo no momento cirúrgico e no sacrifício e as fotos utilizadas para análise clínica do processo de reparo e morfometria. As línguas foram extirpadas e enviadas para processamento histológico, os cortes foram direcionados para coloração em hematoxilina-eosina e em Azul de Toluidina para evidenciação e contagem do número de mastócitos. As características do processo reparativo foram descritas por meio de avaliação qualitativa dos seguintes componentes: extensão de áreas necróticas; intensidade de edema intersticial; tipo e intensidade do infiltrado inflamatório; graus de reepitelização, tecido de granulação e neovascularização. Os cortes corados em HE também tiveram seus campos digitalizados e analisados morfometricamente, para quantificação da reepitelização, mensurações do tecido de granulação, celularidade e edema. Os resultados da análise histológica semiquantitativa evidenciaram que o diclofenaco e a dexametasona acarretaram menor infiltrado inflamatório em relação ao controle na fase inflamatória do reparo, porém na fase produtiva a dexametasona exibiu menor intensidade de reepitelização e de neovascularização em relação aos demais grupos. Os resultados da análise histomorfométrica mostraram significativamente menor edema no grupo do diclofenaco em 6h (p=0,0041) e em 24h (p=0,0429), bem como menor porcentagem da celularidade em 6 horas no grupo da dexametasona (p<0,0001). O grupo diclofenaco ainda exibiu menor área de lesão em 120h do que os demais grupos (p=0,0060), indicando maior eficiência de reparo. Quanto à quantidade de mastócitos em 24, 48 e 120 horas, o grupo controle exibiu significativamente os maiores valores (p<0,0001). Com base nesses resultados, conclui-se que o grupo da dexametasona apresentou pior desempenho em relação à reparação; que o diclofenaco sódico apresentou um melhor efeito sobre o fechamento da ferida cirúrgica e redução mais intensa do infiltrado inflamatório, e que ambos provocam redução de mastócitos na área lesionada. / Inflammation is a protective response to rid the body of the initial cause of cell damage and its consequences, but when excessive and unmodulated, may cause progressive destruction of tissue. The aim of this study is to clarify the influence of two anti-inflammatory, diclofenac sodium and dexamethasone on the inflammatory phase of tissue repair process, as well as on the number of mast cells in different stages of repair. It was used 60 Wistar rats, divided into 3 groups (1, 2 and 3), medicated 30 minutes before surgery (lesion 3 mm in diameter in the ventral tongue), with intramuscular injection of 0.235 mg / kg dexamethasone, 4, 45mg/Kg of diclofenac sodium or sterile saline, respectively. The 3 groups were subdivided into a, b, c, d, according to the time of sacrifice, 6, 24, 48 and 120 hours after surgery. The lesions were photographed immediately at surgical time and at sacrifice, the photos were used for clinical analysis of the repair process and morphometry. The tongues were excised and sent for histological processing, the slices were directed for staining with hematoxylin-eosin and toluidine blue, for disclosure and count of the number of mast cells. The characteristics of the repair process were described through qualitative evaluation of the following components: extension of necrotic areas; intensity of interstitial edema, type and intensity of inflammatory infiltrate; degrees of reepithelialization, granulation tissue and neovascularization. Slices stained with HE also had their fields scanned and analyzed morphometrically to quantify reepithelialization, measurements of the granulation tissue, cellularity and edema. The results of semiquantitative histological analysis showed that diclofenac and dexamethasone led to lower inflammatory infiltrate compared to control in the inflammatory phase of repair, although in the productive phase dexamethasone showed less intensity of reepithelialization and neovascularization compared to the other groups. The results of the histomorphometric analysis showed significantly less edema in the diclofenac group at 6h (p = 0.0041) and 24 (p = 0.0429), as well as a lower percentage of cellularity in 6 hours in the dexamethasone group (p <0.0001). The diclofenac group also exhibited lower lesion area at 120h than the other groups (p = 0.0060), indicating greater efficiency of repair. Regarding the quantity of mast cells 24, 48 and 120 hours, the control group exhibited significantly higher values (p <0.0001). Based on these results, we conclude that the dexamethasone group showed the worst performance in relation to repair; that diclofenac sodium showed a better effect on surgical wound closure and greater reduction of inflammatory infiltration, and that both cause a reduction of mast cells in the injured area.

Introdução: Disfunção cognitiva pós-operatória (POCD) é um evento adverso multifatorial mais frequente em pessoas com idade superior a 60 anos ou doenças neurológicas e psiquiátricas. Este estudo avaliou o efeito da dexametasona sobre a incidência de POCD em idosos após cirurgia não cardíaca sob anestesia geral. Métodos: Cento e quarenta pacientes (ASA I-II, idade 60-87 anos) participaram deste estudo prospectivo, randomizado, envolvendo a administração ou não de 8 mg de dexametasona IV antes da indução anestésica para anestesia geral profunda ou superficial de acordo com o índice bispectral. Os testes neuropsicológicos foram aplicados no pré-operatório e em 3, 7, 21, 90 e 180 dias após a cirurgia e comparados com os dados normativos. Enolase específica do neurônio e S100beta foram avaliados antes e 12 horas após a indução da anestesia. A regressão linear com inferência baseada no método de equações de estimação generalizadas (GEE) foi aplicado, seguido pelo teste post-hoc de Bonferroni, considerando P <0,05 como significativo. Resultados: No terceiro dia pós-operatório, POCD foi diagnosticada em 25,2% dos pacientes que receberam a dose de dexametasona e anestesia profunda, 15,3% nos pacientes que receberam a dose da dexametasona e anestesia superficial, 68,2% do grupo de anestesia profunda e 27,2% do grupo de anestesia superficial (p < 0,0001). Os testes neuropsicológicos demonstraram que a anestesia superficial e a dose de dexametasona antes da indução anestésica diminuiu a incidência de POCD, especialmente para as funções memória e atenção e para a função executiva. A administração de dexametasona preveniu o aumento nos níveis séricos de S100beta no pós-operatório (p < 0,002) bem como está relacionado com uma diminuição significativa nos níveis séricos de enolase específica de neurônio (NSE) (p < 0,001). A memória imediata apresentou diferença entre pacientes com e sem alelo APOe4 (p = 0,025) independente do momento de avaliação. A memória de longo prazo apresentou alteração ao longo dos momentos de avaliação em pacientes com e sem a presença do APOe4 (p = 0,006 e p = 0,017 respectivamente). Pacientes com o alelo APOe4 apresentaram maior percentual de disfunção para memória imediata que os pacientes sem o alelo (p = 0,003). Os pacientes sem o alelo APOe4 apresentaram redução de disfunção para o processo de flexibilidade mental após 180 dias quando comparado aos demais momentos (p < 0,05) e os pacientes com a presença do alelo não apresentaram qualquer alteração estatisticamente significativa (p > 0,999), sendo que após 180 dias os pacientes com o alelo APOe4 apresentaram alteração na função executiva para a flexibilidade mental quando comparados aos pacientes sem o alelo (p < 0,001). Conclusão: A dexametasona pode minimizar a incidência de POCD em pacientes idosos submetidos a cirurgia não cardíaca, especialmente quando associada à anestesia superficial. Efeito da dexametasona sobre os níveis séricos S100beta e NSE pode estar relacionado com algum grau de neuroproteção / Background: Postoperative cognitive dysfunction (POCD) is a multifactorial adverse event most frequently in elderly patients or people aged over 60 years, neurological and psychiatric diseases. This study evaluated the effect of dexamethasone on POCD incidence after non-cardiac surgery and general anesthesia. Methods: One hundred and forty patients (ASA I-II; age 60-87 years) took part in a prospective randomized study involving the administration or not of 8 mg of IV dexamethasone before deep or superficial anesthesia according to bispectral index. Neuropsychological tests were applied preoperatively and at 3rd, 7th, 21st, 90th and 180th days after surgery and compared with normative data. Neuron specific enolase and S100beta were evaluated before and 12 hours after induction of anesthesia. Linear regression with inference based on the generalized estimating equations (GEE) method was applied, followed by the post-hoc Bonferroni test considering P < 0.05 as significant. Results: On the 3rd postoperative day, POCD was diagnosed in 25.2% of patients receiving dexamethasone plus deep anesthesia, 15.3% of the dexamethasone plus superficial anesthesia group, 68.2% of the deep anesthesia group and 27.2% of the superficial anesthesia group (p < 0.0001). Neuropsychological tests showed that dexamethasone plus superficial anesthesia decreased the incidence of POCD, especially memory, attention and executive function. The administration of dexamethasone prevented the postoperative increase in S100? serum levels (p < 0.002) and it is also related with a significant decrease in serum levels of neuron specific enolase (p < 0.001). Immediate memory was different between patients with and without APOe4 allele (p = 0.025) independent of the moment of assessment. The Long-term memory was impaired over the evaluation periods in patients with and without the presence of APOe4 allele (p = 0.006 and p = 0.017 respectively). Patients with the APOe4 allele had higher percentage of dysfunction for Immediate memory (p = 0.003). Patients without the APOe4 allele showed a reduction of dysfunction for the process of Mental flexibility after 180 days compared to the other assessment phases (p < 0.05) and patients with APO?4 allele showed no statistically significant change (p > 0.999), and after 180 days the patients with the APOe4 allele had alterations in Executive function for mental flexibility when compared to patients without the allele (p < 0.001). Conclusion: Dexamethasone can minimize the incidence of POCD in elderly patients undergoing non-cardiac surgery, especially when associated with superficial anesthesia. The effect of dexamethasone on S100beta e NSE serum levels might be related with some degree of neuroprotection