Anesthesia and Dementia
For many years caregivers, who know their loved ones best, have been reporting that after a surgery they have seen a clear decline in their loved ones' mental state. These changes, which some doctors have downplayed as merely anecdotal, have now been confirmed as real.
A report in the March 2009 issue of the Journal of Alzheimer's Disease describes the mechanism behind the relationship between anesthesia and cognitive impairment and the risk for Alzheimer's Disease. In brief, the study indicated that even very short (30 seconds to 5 minutes) exposure to anesthesia induces the addition of phosphorous to tau, a key protein involved in Alzheimer's Disease and several other neurodegenerative disorders. Exposure of more than one hour significantly increased the amount of phosphorus. The end result is an decline in cognitive function, often called Post Operative Cognitive Decline, which may be permanent.
Because they often require a lengthy period of anesthesia, major orthopedic and cardiac surgeries are particularly risky procedures for the elderly, even if they are not showing any signs of dementia before surgery. There will be times when you have no choice, but it is important to talk with your elder's doctors to thoroughly explore all the possible alternatives before you opt for surgery under general anesthesia.
If your elder must have a surgical procedure there are several things you can do to help him or her weather the hospitalization.
Make sure you or another family member can give a good medical history to the many different staff members who will ask the same questions over and over. Even if your elder is alert and aware, exhaustion can set in and important details can be left out on the tenth request to repeat information. Bring a dozen copies of your loved one's medical history and medication list, including any past bad responses to particular drugs. In addition to repeating the history verbally, hand these copies out to everyone.
Plan for someone who knows your elder to be there all the time. Request permission to be at the bedside in the recovery room. You may not be allowed, but you have nothing to lose by asking. Post-operative confusion will be at its worst in the recovery room. If you are there to soothe and supervise you may be able to prevent your patient from pulling at tubes and IV lines or trying to climb out of bed. When there is no one at the bedside, staff are more likely to use drugs or restraints to prevent these behaviors.
Once back in the room your senior will still need someone there 24/7 until you are sure he or she is not overly confused. Hospital staff will be in and out, but none of them have much time to spend with an individual patient. Your parent may be too confused to use the intercom system if she needs something. Your elder will need the security of having someone they know, and who knows them, to help them with orientation, to reassure them, and to remind them about what they need to do. It will be especially important to be watchful about agitated attempts to get out of bed and other dangers. If you can't be there, ask the hospital for a list of sitters who can fill in for you.
Check your elder out as soon as you safely can. The hospital environment, with strangers popping in all day and all night to do uncomfortable or even painful things, loud sounds in the halls at all hours, a strange bed and unfamiliar food will all contribute to confusion and agitation. Obviously you won't want the hospital to discharge your patient too early, but as soon as it's safe it will be helpful to get to a less chaotic environment.
Be prepared even for the healthiest senior to be "fuzzy" for a while. Not every older person who has anesthesia becomes permanently impaired, but most report that they have a certain degree of "brain fog" for weeks or months post-surgery. Those with a pre-existing dementia are most likely to experience a long lasting decline. Be prepared for your senior to need more help than before, even if he or she recovers physically from the actual procedure.