Go­ing un­der the knife may dam­age mem­ory

The Daily Telegraph - - Front page - By Sarah Knap­ton SCI­ENCE EDI­TOR

Pa­tients are twice as likely to suffer a sub­stan­tial de­cline in men­tal skills af­ter ma­jor oper­a­tions, a study sug­gests. Doc­tors have long feared that gen­eral anaes­thetic, mini-strokes or in­flam­ma­tion might dam­age the brain dur­ing surgery, but un­til now there has been lit­tle ev­i­dence of a long-term im­pact. The study of more than 7,000 Bri­tish civil ser­vants, tested be­tween 1997-2016, also found ma­jor surgery aged the brain by an av­er­age of just over four months.

MA­JOR surgery dou­bles the chance of ex­pe­ri­enc­ing a sub­stan­tial de­cline in men­tal skills, in­clud­ing rea­son­ing, mem­ory and lan­guage abil­ity, a study sug­gests.

Doc­tors and scientists have long feared that gen­eral anaes­thetic, min­istrokes or in­flam­ma­tion may dam­age the brain dur­ing surgery, but there has been lit­tle ev­i­dence to demon­strate a long-term im­pact.

Now a lon­gi­tu­di­nal study of more than 7,000 Bri­tish civil ser­vants, who were tested be­tween 1997 and 2016, has found that those who un­der­went ma­jor oper­a­tions were twice as likely to suffer sub­stan­tial cog­ni­tive de­cline than those who did not have surgery.

Although the re­search did not cover de­men­tia, cog­ni­tive de­cline can pre­cede or speed up its de­vel­op­ment be­cause of a re­duc­tion in brain re­silience.

While the study, pub­lished in the BMJ, showed around one in 40 peo­ple suf­fered a sig­nif­i­cant re­duc­tion in men­tal abil­ity dur­ing the 19-year fol­low-up pe­riod, the num­ber rose to more than one in 18 for those who had a ma­jor op­er­a­tion. Ma­jor surgery was also found to age the brain by an av­er­age of four months and three days.

Re­searchers from the Univer­sity of Wis­con­sin said it was un­clear whether the ef­fect was driven by the op­er­a­tion it­self, or the un­der­ly­ing med­i­cal con­di­tion that had ne­ces­si­tated the surgery.

How­ever, they said pa­tients should be warned of the po­ten­tial for dam­age when dis­cussing a fu­ture op­er­a­tion.

“The cog­ni­tive ef­fects of surgery should be con­sid­ered along­side the other po­ten­tial health ben­e­fits,” said Robert San­ders, an as­sis­tant pro­fes­sor.

“Po­ten­tial mech­a­nisms” of brain in­jury dur­ing the surgery process in­cluded strokes, mini-strokes and in­flam­ma­tion, while “long-term cog­ni­tive health” may also be in­flu­enced by post­op­er­a­tive pain and some med­i­ca­tions, he added.

Re­searchers ex­am­ined data from 7,532 men and women re­cruited from the Civil Ser­vice in Lon­don be­tween 1985 and 1988. From 1997, a bat­tery of tests – re­peated four times un­til 2016 – mon­i­tored their men­tal abil­ity.

Dur­ing that 19-year pe­riod, 1,250 were ad­mit­ted to hospi­tal for ma­jor surgery, and af­ter ac­count­ing for agere­lated

‘The cog­ni­tive ef­fects of surgery should be con­sid­ered along­side other po­ten­tial health ben­e­fits’

cog­ni­tive de­cline, the au­thors cal­cu­lated that this was as­so­ci­ated with brain ageing of just over four months.

Be­ing ad­mit­ted for a med­i­cal con­di­tion, such as a heart at­tack, led to a men­tal de­cline of 1.4 years, while a stroke aged the brain by 13 years.

Fiona Car­ragher, the chief pol­icy and re­search of­fi­cer at the Alzheimer’s So­ci­ety, said: “Hospi­tal ad­mis­sions and the state of delir­ium that can re­sult from ex­tended stays can have a neg­a­tive im­pact on cog­ni­tion among peo­ple with de­men­tia.

“[This study] points to­wards the im­por­tance of con­sid­er­ing cog­ni­tive health dur­ing hospi­tal ad­mis­sions. Our own re­searchers are hard at work [on] so­lu­tions and train­ing pro­grammes.”

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