“Doctor, ever since my surgery, I don’t remember things as well as I used to and sometimes, I have trouble concentrating—Why?”
Doctors and their patients, the world over, are grappling with this question and the answer is still elusive. Something mysterious happens to the brain-especially the older brain-as a result of surgery that scientists are trying to unravel. Perfectly lucid patients go into surgery and come out somewhat dazed and confused, beset by delusions and occasional hallucinations. Usually, the confusion subsides after the anesthesia wears off but in some cases patients experience what is now known as postoperative cognitive dysfunction (POCD) which is characterized by memory lapses, inattention and inability to concentrate. These problems can persist for weeks or months or even years after surgery. Some scientists blame the trauma of surgery which may curtail blood flow; others, the effects of anesthesia. Are age, gender, pre-existing illnesses or types of surgery factors to be considered? It’s hard to say because there is no standard diagnostic criteria for doctors to determine who is at risk and who isn’t.
Consequently, what causes this decline and why some patients are more susceptible than others is at the core of new research. The American Society of Anesthesiologists launched a Brain Health Initiative to identify possible causes and preventative measures. Their research uncovered a possible answer: inflammation of the brain. Researchers were able to rule out general or local anesthesia as culprits focusing on the trauma of surgery itself. They looked at various data sets related to elderly patients as well as to twins— who suffered from POCD as a result of surgery versus those who were surgery-free. They also looked at types of surgical procedures and anesthesia used. They ended up hypothesizing that surgery itself releases a body-wide inflammation impacting the brain among other organs.
Now under consideration are possible treatment options such as having patients take anti-inflammatories during or after surgery—however, side effects may pose problems for certain patients. Brain training such as games or puzzles are also being considered for strengthening cognitive skills prior to surgery. As yet, no real approach has been sanctioned. Moreover, it may take years of additional research to determine with greater certainty the real reasons behind POCD. A Canadian researcher and his colleagues have begun to track cognitive skills in people scheduled for knee and hip-replacements. Patients will take cognitive tests before and after surgery to help rule out existing conditions but clearly more needs to be done globally to cover other invasive and noninvasive surgeries involving cardiovascular and other surgical procedures.
In the interim, if you are facing surgery, consult with your doctor on the best course of action to protect both your health and your mind.
Want to learn more about the Post-Op Brain? Visit Science Magazine.