March 21, 2019
by Sandra Gordon for ASA
Over the past three years, Jay Zemel has undergone four different surgical procedures that required anesthesia for medical issues ranging from a fractured arm to hernia repair. “I’ve never been very good at recalling proper names and nouns,” says the H. Nedwill Ramsey, professor (emeritus) of sensor technologies at the University of Pennsylvania, who just celebrated his 90th birthday. Forty years ago, for example, Zemel couldn’t immediately recall the name of his eldest daughter at a party (“to her great amusement,” he says).
Still, after his recent surgeries, he has noticed that his memory seems to have deteriorated. “The best way I can describe is that I notice a fogging of my mental processes. Yesterday, for example, while talking with a colleague, I couldn’t recall the name of a man I had worked with for years. I could visualize his face but not his name. It’s very irritating,” Zemel says.
At the University of Pennsylvania’s Institute on Aging, Zemel is also a research subject. “They’ve been watching me for years,” he says. “They’ve taken a sample of my spinal fluid and once a year, I have a psychological exam with all kinds of tests related to recall—remembering a story, numbers, the names of animals. They don’t tell me the results, but I suspect there’s been attrition.”
Zemel doesn’t know if his recent memory lapses are related his advancing age, the anesthesia or the surgery itself. Still, he isn’t letting his memory slip away, if he can help it. As a still-active research scientist, “the status of my brain is of central importance to me,” Zemel says.
To counter this apparent memory recall issue, “I engage daily in a variety of cognitive activities ranging from detailed analyses of a large body of scientific data central for potential clinical applications to daily crosswords, cryptograms and sudokus, and a reasonably active social life,” Zemel says.
But being physically active seems to be helping the most. Instead of driving to work (Zemel recently stopped driving at the urging of his adult daughters), he now takes the train to the 30th Street Station in Philadelphia and walks to work at the University of Pennsylvania from there. Instead of thinking of ways to take a vehicle to a meeting across campus, Zemel hoofs it. “All I do is walk, walk, walk, and the consequence has been positive,” Zemel says. “I’ve have noticed that my thinking has gone from slightly foggy to much clearer.”
Evidence linking exercise and improvements in brain health is building. As Culley and Crosby stated in Prehabilitation for Prevention of Postoperative Cognitive Dysfunction? in Anesthesiology 2015: “Surgery sets the old brain on fire and prehabilitation is a fire retardant.” Similarly, in a related study in Anesthesiology 2015, Kawano and associates demonstrated that perioperative environment enrichment could prevent the development of neuroinflammation and related postoperative cognitive dysfunction in aged rats by revering a proinflammatory phenotype of hippocampal microglia.
While we don't yet know the exact prescription for the amount or type of exercise, it seems that encouraging older patients to gently increase their physical activity before elective surgery will not only improve their cardiovascular fitness but positively impact their brain. Likewise, early appropriate mobilization after surgery will have mental and physical benefits.
Reading from his iPhone, Zemel recites how much he’s walked in the past few days: Yesterday, 3.4 miles and seven floors. The day before, it was only two-tenths of a mile, but on Monday, he covered two miles and four floors. “It varies from day to day, week to week,” Zemel says. “I’m not trying to be a hero. I’m very much aware of the multiple dangers, both intellectually and physically, in terms of balance issues that arise as you age. I want to do just enough to be a good old geezer and I am extraordinarily fortunate.”
Overall, Zemel feels better, including the memory part. “That to me is the most important aspect of it,” Zemel says. “So long as I feel that my intellectual capability hasn’t deteriorated too much, I’m happy. That means I still have a life.”
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