Cognitive dysfunction a concern for elderly post-op patients

DEAR DOCTOR » My 81-yearold father is scheduled for a heart procedure, and I’m actually less worried about the surgery itself than the effects of the anesthesia. I’ve read that it can lead to memory loss in the elderly. Is there any way to help him?

DEAR READER » The condition you’re referring to is known as postoperative cognitive dysfunction, sometimes shortened to POCD. It’s loosely defined as impairment to the mental functions of an individual following surgery performed under general anesthesia. And while your question zeros in on anesthesia as the cause of those cognitive side effects, the jury is still out on that. Some researchers point to the rigors of surgery itself as well as the body’s resulting inflammation response as contributing factors to the condition.

Symptoms of POCD include impaired memory, difficulty learning and retaining new information, a shortened attention span, problems carrying out more than one task at once and a decline in the ability to concentrate. These can develop over time following surgery and may last a few weeks, a few months or in some cases become permanent. While the condition can occur in any surgical patient, it’s most often seen in elderly individuals.

One of the challenges to diagnosing POCD is that unless the patient has undergone pre-operative cognitive testing, assessing his or her postoperative condition relies on observational and anecdotal evidence. In cases where the syndrome is pronounced, a reliable diagnosis can be made. But in more subtle cases, where those around the patient feel he or she has “lost a step” following surgery, citing POCD as the direct cause becomes more difficult. With that in mind, we’d like to share with you the following recommendations from the American Society of Anesthesiologists:

• Before surgery, undergo a cognitive test that can be used as a baseline against which to compare similar post-surgical testing, if needed.

• Make sure your surgeon is familiar with all medications and supplements you’re taking in the weeks and days before surgery, and any that you plan to take following the procedure. This includes medications to address pain, sleep and anxiety.

• Patients who wear glasses or use hearing aids find it easier to re-enter the post-surgical world when their sight and hearing are at optimal levels. Assign someone the task of making them available to you as soon as possible following surgery.

• Arrange for a caregiver, who can notice and report any troubling symptoms, to visit with you regularly as you recover.

• Anchoring yourself in the present as soon as possible after surgery is important. Request a room with a window, so you have visual cues regarding the passage of time, as well as your physical location.

• In that same vein, photos of family, friends and pets, familiar possessions, and a clock and a calendar, all can help you readjust.

With an aging populace, many of whom will go on to require surgery, recognizing and preventing POCD is rapidly becoming a public health issue. A wide range of researchers are now focused on it. As new findings emerge, we will share the latest information.