Will having an op wreck my memory?

DOES general anaesthetic affect your memory? In the past eight years I have had six general anaesthetics and my memory is not as good as it once was. Or is my memory loss down to old age? I am 72. Stuart Ballard, by email.

You and many others will be reassured to hear that general anaesthetics are not a proven cause of long-term memory loss.

Although there is much debate on the subject, there is no evidence that the drugs used in anaesthesia cause damage to the tissue of the brain.

Your concern is not unusual, however. It is a universal experience that after the age of about 50, people find their memory is not as sharp as it used to be. They tend to have particular trouble remembering names and recent events, such as what they had for lunch yesterday.

It’s a common issue that people see their GP about. Like you, they often voice anxieties about anaesthetic — after all, so many people in this age group will have had surgery or will be scheduled to have an operation — or they’re worried their memory has been affected by prescribed medication.

In the background, there is the fear that dementia is on the horizon. Yet these sorts of memory difficulties can be a normal part of the ageing process: brain scans of elderly people suggest the brain shrinks with age.

It is a matter of judgment and considerable expertise for doctors to differentiate between normal ageing and a condition known as mild cognitive impairment, an intermediate state between normal function and early dementia.

The cornerstone of the evalua- tion is the medical consultation. This face-to-face examination gives the patient’s GP a sense of the extent of the problem and enables them to make comparisons with others of the same age.

It is one reason why it is so important to be seen by a doctor who knows you and has followed you over the years.

There are also screening tests available that GPs, neurologists and psychiatrists use, for instance a questionnaire called the minimental state examination. This includes questions about the date and time; it also tests the patient’s ability to recall a list of words, to do mental arithmetic and to spell a word backwards.

When the result of this test is abnormal it will be followed by more detailed neuropsychological testing. This usually involves longer tests under the care of a clinical psychologist, who will use questionnaires to determine which areas of cognitive function are affected.

The patient may also undergo a CT or magnetic resonance brain imaging scan to check for cerebrovascular disease (where there are problems with blood supply to the brain — a possible cause of dementia) and other issues.

It would be unwise of me to venture an opinion about your own situation, but from what you have told me it is worth having a conversation with your GP.

I must stress again, however, that general anaesthetic is unlikely to have been the cause.

I HAD my gallbladder removed a year ago and now my wife needs hers removed. Is this normal? Or could there be something else going on in both of us that we should be tested for?

Alan Daly, by email.

The gallbladder is a reservoir for storing bile — a fluid that helps with digestion — that has formed in the liver.

If it starts to malfunction (for reasons that are not fully understood), then small stones — usually made of cholesterol — can form inside it, potentially triggering symptoms such as pain in the abdomen and vague sensations such as bloating, heartburn, acidity and belching.

The diseased gallbladder can also become infected — known as acute cholecystitis.

Symptoms and infection are not inevitable, but once they do start to occur then the recommended treatment is to remove the gallbladder ( known as cholecystectomy).

Your body does not actually need a gallbladder, and after the operation the digestive system will adapt and function normally. Gallstone disease is common. Around 6 per cent of men and 9 per cent of women are thought to have gallstones, though only about 20 per cent of those with stones will develop symptoms.

To answer your question we need to look at the risk factors for developing gallstone disease, and there are many of these.

Age is the major risk factor (stones usually develop in middle age). Being female is a risk factor, as is being pregnant or having been pregnant in the past, because oestrogen, the female sex hormone, alters the chemistry of the bile. For the same reason, taking oral contraceptives or hRT also increases the risk.

Family history is a risk factor along with obesity, diabetes and cirrhosis (scarring of the liver) and having a sedentary lifestyle.

Given the frequency of this condition, and the numerous risk factors, the fact that both you and your wife have developed gallstones does not suggest either of you has a sinister underlying condition. Although you may lead similar lifestyles, it is basically a coincidence, and your respective risk factors will be somewhere in that long list. There is no reason to undergo any other investigations.