Elective surgery puts seniors at risk for long-term cognitive problems

Jan 3 2008

According to new research from the U.S. patients over the age of 60 who opt to have elective surgeries put themselves at an increased risk for long-term cognitive problems.

The researchers also say older people who undergo non-emergency, inpatient procedures such as joint replacements and hysterectomies and then develop postoperative cognitive problems are more likely to die in the first year after surgery.

The new study, led by Duke University Medical Center researchers, measured memory and the ability to process information in more than 1000 adult patients of different ages.

The patients were tested before surgery, at the time of hospital discharge, and three months after surgery and were compared to more than 200 control subjects given the same tests at the same frequency, who did not undergo surgery or anesthesia.

Lead investigator Dr. Terri Monk, an anesthesiologist at Duke and the Durham Veterans Affairs Medical Center, says though it is known that patients undergoing heart surgery are at risk for cognitive dysfunction such as problems with memory, concentration and the processing of information, the effects of non-cardiac surgeries on brain function were not so clear.

Dr. Monk says the study found that increasing age put elderly patients at greater risk for cognitive problems which is significant because the elderly are the fastest growing segment of the population.

Also it is acknowledged that half of all people 65 and older will have at least one surgery in their lifetime.

The research revealed that while many of the young, middle-aged and elderly patients experienced postoperative cognitive dysfunction (POCD) on leaving hospital, three months later, those aged 60 and older were more than twice as likely to exhibit POCD and they were also were more likely to die within the first year after surgery, says Monk.

Dr. Monk says POCD was more common among those patients with lower educational level and a history of a stroke that had left no noticeable neurologic impairment.

She suggests that education protects against postoperative cognitive problems possibly because it conditions and equips the brain to better withstand injury, in much the same way that physical exercise has a protective effect on the body.

Dr. Monk says why cognitive decline is associated with early death is not completely understood, but it’s possible that patients with prolonged cognitive dysfunction might be less able to take medicines correctly or may not recognize the need to seek medical care for symptoms of complications.

Dr. Monk suggests that surgery and the accompanying anesthesia might cause inflammation in the brain which can affect a patient’s ability to learn, retain or remember information.

Dr. Monk says doctors need to devise strategies to prevent or mitigate the detrimental effects of surgery and anesthesia on the aging brain.

The research which was funded by the National Institute on Aging, the Anesthesia Patient Safety Foundation and the I. Heerman Foundation, is published in the current issue of the journal Anesthesiology.