Impairment after surgery is common

Dear Dr. Roach: I am a 67-year-old estate planning attorney. Last year I had back surgery and experienced substantial cognitive impairment. It has been over a year, and I have recovered perhaps 80% of my prior function. I would appreciate your thoughts on this. — A.L.

Any kind of surgery can lead to a temporary decline in cognitive abilities. The term “perioperative neurocognitive disorders” is used to describe the spectrum of changes.

A sudden change in mental function is termed “delirium” when there is a fluctuation in mental status in addition to changes in thinking. This is different from dementia, which is a slower, usually progressive, loss of cognitive abilities and usually other abilities.

Temporary loss of cognitive abilities is much more common in older people. While changes within the first 24 hours are extremely common, 12% of people were found to have post-operative cognitive dysfunction three months after surgery in a group where the average age was 68. Older age, lower baseline level of education and use of sedatives were found to be risk factors in an analysis of many studies. Your age and education did not put you at high risk. Further, prolonged symptoms past a year are less common.

Having a degree of cognitive impairment prior to surgery is a major risk factor. Many very high-functioning patients can develop some degree of dementia without their or their family’s realizing it.

Regardless of risk factors, some people never recover 100% of their function, and we have no good way of identifying who will have permanent problems. Up to 40% of older people who develop post-operative delirium never recover to where they were before surgery. There are no known treatments for delayed recovery of the type you describe.

I wish I had more optimistic news for you.