What Are The Symptoms Of Pocd
Common symptoms of POCD include problems with memory, attention, and concentration, from months to a lifetime after surgery. For instance:
- Difficulty remembering recent happenings
- Insufficient ability to concentrate on reading a book or newspaper
- Reduced ability to perform arithmetic
Also, people with POCD easily become tired.
The Effects Of Anesthetic Agents On Pocd
Several studies have also been designed to assess whether the risk of POCD differs with general anesthesia using inhalational agents, vs. GA with TIVA . A recent meta-analysis combined data from seven studies, and concluded that TIVA may reduce the risk of POCD, with an odds ratio of 0.52 however, this certainty of this conclusion is low due to heterogeneity of diagnostic tools utilized, variability in time of assessment, and inconsistent data reporting . Furthermore, the authors reported that there were 11 ongoing studies on the topic at the time of the meta-analysis in 2018. At this time, it would be premature to conclude superiority of one mode of anesthetic.
Limited available data also demonstrates mixed results regarding the impact of other modifiable factors on POCD risk including hypothermia and pre-operative and intraoperative glycemic control . Further prospective RCT evidence is required to evaluate the contribution of these factors to delayed neurocognitive recovery.
Consent: Individuals over the age of 65 should be informed of the risk of postoperative delirium and perioperative neurocognitive disorder prior to their procedure
Baseline cognitive assessment: Cognitive function should be assessed preoperatively using a brief screening tool. Examples of screening tools provided included the Minicog, MoCA, MMSE, clock-drawing test, verbal fluency test, or the cognitive disorder examination
Older Adults Are Having More Surgical Procedures
As our population ages and medicine and healthcare advances, more older adults are likely to develop serious conditions and undergo surgical procedures to treat or manage these conditions. Recent surveys suggest that progress in surgical techniques and control of anesthesia has increased surgical procedures in older people, with approximately 30% of all surgeries being conducted in people over the age of 70.
While advances in medicine may help people live longer, older adults are more likely to develop complications due to surgery. Some research suggests approximately one-quarter of those over 75 undergoing major surgery will develop significant cognitive decline, and about half of those people will suffer permanent brain damage.
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Who Is At Risk Of Pocd
Besides age, other factors that increase patients risk of POCD include:
- Preexisting cognitive issues, such asmild cognitive impairment ordementia. MCI is a transitional phase between normal mental function and Alzheimer’s disease or other forms of dementia.
- Medical conditions such asdiabetes or cerebrovascular disease, which reduces blood flow and oxygen to the brain and increases the risk ofstroke
- Lower education levels or lower IQ scores
- A low preoperative vitamin D level
POCD risk also varies by type, complexity, and length of surgery. Dr. Anderson explains:
- Cardiac surgery seems to be one of the highest risk surgeries. As high as 40 percent can have postoperative cognitive decline. The age of patients most commonly having cardiac surgery contributes to this elevated risk level.
- As the complexity and the length of surgery goes up, so does the risk of postoperative cognitive decline. A knee scope has relatively minimal risk compared to a six-hour abdominal surgery, for example.
- Trauma and surgeries associated with trauma, such as hip fractures and car accidents, tremendously increase your risk.
People over age 60 are two times more likely to encounter POCD than younger surgery patients.
Does Anesthesia Cause Memory Problems In Adults
22 February 2018
Going under for surgery might lead to future memory problems, but any effects appear to be small, a new study suggests.
Middle-age adults who underwent surgery using general anesthesia performed slightly worse on memory tests afterward, according to the study, published today in the journal Anaesthesia. The people in the study had no signs of Alzheimers disease or dementia, or even mild cognitive impairment, before the surgery.
However, though the changes were noticeable for researchers, the cognitive changes after surgery are small most probably asymptomatic and beneath a persons awareness, study author Dr. Kirk Hogan, a professor of anesthesiology at the University of Wisconsin-Madison School of Medicine and Public Health, said in a statement.
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The Real World And Selective Blindness
Nearly all physicians, together with nearly all non-medical people, as well as the popular press, attribute these changes in mental function to the effects of anesthesia. Many of these people even believe that anesthetic drugs remain in the body for many months exerting a deleterious effect upon mental function. This is the real world of people who themselves have experienced POCD, or who have relatives who manifested POCD.
Most people believe anesthesia is the cause of POCD, yet seem to forget that administration of anesthesia is never done without a purpose. This is a curious form of socio-culturally induced selective blindness. No one undergoes anesthesia without undergoing an operation. Anesthesia is always administered to make surgical procedures, or an operation, possible. So POCD is always a consequence of the combined effect of anesthesia plus surgery upon mental function. In fact the effects of surgery upon the functioning of the body can be quite profound. For example, major surgery has an effect upon body function comparable that due to being hit by a truck, only the wounds are tidier. Recovery from such major injury also has a long-lasting effect upon mental and body function. There are also several other factors determining whether a person develops POCD. In fact, studies reveal reasonably consistent information about who is most likely to develop changed mental function after anesthesia and operation. These are listed below.
Management Of Pocd Or Other Mental Changes After Surgery
People reporting changed mental function after undergoing an operation should be taken seriously. The discussion above reveals this to be a real and serious problem, and one which potentially has an enormous impact upon the personal functioning of the individuals concerned, as well as a significant impact upon their surroundings and the societies in which they live. Management should be serious and efficient. Why efficient? That sounds cold and unpleasant. Actually, efficiency is of utmost importance. Delay and incorrect management reduces the chance of successful management, as well as increasing the distress of the individuals concerned and their families. Rapid placement of people into correct treatment regimes improves the chances of successful management, and means the incurable are placed in appropriate support programs.
Here are some personal thoughts regarding general management of POCD and postoperative altered mental function according to when they occur, and how long they last.
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What Are The Effects Of Anesthesia On The Brain
Whether or not medical research can pinpoint a direct link between general anesthesia and the subsequent risk for memory issues, one fact is clear: Anesthesia drugs travel into the brain and lodge it into a state of amnesia loss of consciousness, immobility and decreased blood flow to the brain result.
The Capacity Of Short
Your short-term memory has a limited capacity. Certain studies conducted by the famous George Miller in the 1950s are often used as the guideline for determining how much capacity the short-term memory has. It is estimated that working memory can hold five to nine items at a time. However, newer studies have shown that in different age groups, the number is much lower, around four to five items.
The type and characteristics of the information also make a difference in how much can be stored in short-term memory. There have also been studies that have shown that short-term memory capacity and how long information remains in short-term memory can be increased if the information is said aloud.
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Why Do Surgery And Anesthesia Cause Problems With Thinking For Older Adults
There are degenerative changes in the brain with aging that predispose people to cognitive changes from surgery. Hence, age is a risk factor that needs to be considered when making decisions about surgery. Education level, mental health, and pre-existing medical conditions are also factors that affect an older persons postsurgical cognitive functioning. People with higher levels of education tend to have more active brains due to regular mental stimulation. Mental and social activities promote brain health and decrease the risk of dementia and cognitive decline with normal aging.
Pre-existing medical conditions such as obesity, hypertension, coronary artery disease, diabetes, chronic kidney disease, stroke, and dementia predispose older adults undergoing surgery to more risk of postoperative cognitive decline. The reason these diseases cause cognitive decline is related to systemic inflammatory markers in the blood proteins that are released into the bloodstream as a result of inflammation in the body. These markers enter the brain following a break in the blood-brain barrier during the postoperative period, resulting in inflammation in the brain. This blood-brain barrier dysfunction is frequently seen in older people , and has been seen in approximately 50% of patients undergoing cardiac surgery.
Is It The Surgery Or Is It Anesthesia
Surgeries are not easy, and theprocedure can put a lot of strain on our body and our mind. Surgeries are knownto cause inflammation in our body, which often affectsour mental and physical functions, albeit temporary.
Unfortunately, elderlies are mostlikely to suffer from infections and inflammations after surgery. It takes sometime for the cells damaged in the process to recover from the trauma. It is whythere is a noticeable change in behaviorin most patients. Due to the inability toutilize their full mental or physical potential, the patient may appear disorientated.
Some people even go as far assaying that the person has completely changed after the surgery. Most studiesin such cases have revealed that the patients gradually go back to being theirprevious selves.
Since older adults tend to be frail,they are most likely to be affected by the impact of surgery. They may even take longer to recover. Thisfrailty factor is one of the biggest reasons scientists have yet to blame itall on anesthesia.
Now, to understand if therereally is a connection, and to what extent, we need to look at all the majorstudies conducted in this regard.
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Feeling loopy or out of it for a couple of days after surgery is super common and generally resolves pretty quickly, says Richard Anderson, MD, a Premier Health anesthesiologist and medical director of perioperative services at Miami Valley Hospital South. Postoperative delirium is the formal name for this post-surgery fog.
But another condition, postoperative cognitive dysfunction or decline , can have more lasting effects on memory, attention, and concentration from months to a lifetime. First described about a century ago, POCD has relatively recently become the subject of more intense medical study, Dr. Anderson says.
Theres never been an agreed-upon diagnostic criteria for POCD, and its not routinely screened for, he explains. But thats changing.
Why? First, people over age 60 are two times more likely to encounter POCD than younger surgery patients.
We have such an aging population now, that the proportion of patients who experience POCD, or are at risk for it, is just going to skyrocket over the next decade.
Dr. Anderson adds, Patients are very interested in POCD now. The more educated patients get and the more they read about it in the popular media, they are starting to ask about it.
- How are we going to screen patients before surgery?
- Who is at risk?
- What are we going to do about it in terms of anesthesia technique?
- And how do we follow patients after surgery?
Is It Alzheimer’s Or Another Kind Of Dementia
Alzheimer’s disease is the most common cause of dementia and causes significant memory loss, in addition to multiple other symptoms. If you think your memory loss could be caused by Alzheimer’s, review the symptoms and make an appointment with your physician for an assessment. Although Alzheimer’s typically affects those over the age of 65, early-onset Alzheimer’s can occur in those as young as 40.
Memory loss can also be caused by other kinds of dementia, such as vascular dementia, Lewy body dementia, frontotemporal dementia, and several others. Problems with memory should be discussed with your doctor so that any reversible cause can be found and treated, or so that treatment for Alzheimer’s or dementia can begin as soon as possible if this is the cause.
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Are There Strategies To Avoid Cognitive Decline In The Postoperative Period
Benjamin Franklin once said, An ounce of prevention is worth a pound of cure. No other condition exemplifies this saying better than preventing postoperative cognitive decline.
The following are some strategies you and your caregivers can use to prepare for surgery.
Before surgery is scheduled:
- Remain socially active and connected.
- Reduce stress. Meditation significantly reduces stress and promotes a sense of calm and overall well-being.
- Practice good sleep habits and try to get six to eight hours of sleep a night.
When surgery is scheduled:
Schedule a comprehensive geriatric assessment. This enables your physician to diagnose reversible aspects of frailty preoperatively and take adequate measures in a timely manner, such as altering medications you may be taking, and/or postponing surgery if you are extremely frail, to improve nutrition and incorporate lifestyle changes.
Talk to your surgeon about the risks and complications of the procedure. If you are having heart surgery, ask if a cardiopulmonary bypass machine will be used, and whether it is important to your surgery.
Talk to your anesthesiologist about
After surgery and during recovery:
Caregivers need to be informed about the need for keeping their loved one active and following physical rehab recommendations, and providing mental stimulation in the postoperative period. Puzzles, sudoku, board games, books, etc., will keep someone entertained while simultaneously providing them with some brain activity.
What We Know And Dont Know About Memory Loss After Surgery
Navigating Aging focuses on medical issues and advice associated with aging and end-of-life care, helping Americas 45 million seniors and their families navigate the health care system.
To contact Judith Graham with a question or comment, .
Two years ago, Dr. Daniel Coles 85-year-old father had heart bypass surgery. He hasnt been quite the same since.
He forgets things and will ask you the same thing several times, said Cole, a professor of clinical anesthesiology at UCLA and a past president of the American Society of Anesthesiologists.
He never got back to his cognitive baseline, Cole continued, noting that his father was sharp as a tack before the operation. Hes more like 80 percent.
The old man likely has postoperative cognitive dysfunction a little-known condition that affects a substantial number of older adults after surgery, Cole said.
Some patients with POCD experience memory problems others have difficulty multitasking, learning new things, following multistep procedures or setting priorities.
There is no single presentation for POCD. Different patients are affected in different ways, said Dr. Miles Berger, a POCD specialist and assistant professor of anesthesiology at Duke University School of Medicine.
Unlike delirium an acute, sudden-onset disorder that affects consciousness and attention POCD can involve subtle, difficult-to-recognize symptoms that develop days to weeks after surgery.
Side Effect #: Itching
A curious side effect of narcotic pain medication is itching. Most people complain of itching on their face, especially the tip of the nose. Sometimes, people will have significant, all-over body itching and believe they are having an allergic reactionand it can be hard to tell the differencebut most of the time, its just a side effect.
Luckily, Benadryl can easily treat this side effect. However, first make sure its okay to take over-the-counter medicines with the prescriptions you have been given. In the hospital, patients can get a special medicine that block the receptor responsible for itching but not pain relief, which is even more effective.
Narcotics are routinely used during anesthetics to block pain receptors and often cannot be avoided. Tell you anesthesia provider if you have had this bothersome side effect in the past.
Cognitive Effects Of Anesthesia On The Elderly
As a person ages, the chance that they will need to undergo surgery requiring the use of general anesthesia increases. In fact, studies have estimated that 53 percent of all surgical procedures are performed on patients over the age of 65.
General anesthesia describes the combination of intravenous and inhaled drugs used to render an individual unconscious and unable to feel pain during an operation. This type of intervention is typically used for surgeries that will take a long time to complete, cause a great deal of physical and/or mental discomfort, or possibly interfere with a persons ability to breathe.
The process of going under usually does not present a problem for younger, healthier individuals. After a few days, any residual feelings of grogginess or confusion typically wear off. However, older individuals process these drugs differently and can experience more severe side effects that may outweigh the benefits of certain surgical procedures.
The Connection Between Anesthesia Delirium And Dementia
When examining the potential cognitive effects of general anesthesia on older adults, it is important to first make the distinction between two commonly confused conditions: delirium and dementia.
While these ailments share similar symptoms, such as confusion, problems with perception, mood swings and decreased cognition, there are crucial differences between them. Delirium refers to abrupt, temporary changes in a persons mental functioning, whereas dementia describes a more gradual, permanent decline in cognitive abilities caused by chemical and/or anatomical changes in the brain. People with dementia can exhibit signs of delirium, but the two terms are not interchangeable.
Postoperative delirium is a common cognitive after-effect of general anesthesia, particularly for the elderly. The American Society of Anesthesiologists explains that confusion, difficulty focusing and memory issues associated with postoperative delirium can come and go and usually disappear after about a week.
Postoperative cognitive dysfunction is a more severe condition that may affect seniors who have received monitored sedation or general anesthesia. POCD is characterized by marked changes in cognition and both short- and long-term memory that can persist for weeks or months after a significant surgery. According to the ASA, the following chronic conditions can increase a seniors risk for POCD:
- Heart disease
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