April 19, 2018
by Sandra Gordon for ASA
“The day after having surgery under general anesthesia, my memory was worse and my mind was slower than before surgery,” says Russell, 70, a retired geologist with a Ph.D. who was 59 at the time of his 2002 prostatectomy. “It was harder for me to see connections between subtly related bits of information. Word finding also became harder. These changes persist almost 16 years later. I write to you in case this description of an occurrence of apparently permanent postoperative cognitive dysfunction might be useful to you.”
Russell’s story is just one of the many spontaneous emails Roderic Eckenhoff, M.D., the Austin Lamont professor and vice chair for research at the University of Pennsylvania Perelman School of Medicine, continues to receive after being featured in the June 2017 Science article on postoperative cognitive dysfunction: “Will surgery sap your brain power?”
The random patient accounts are diverse. “I’ve received emails from people in their 40s, who’ve had their first event, to people much older,” Dr. Eckenhoff says. But according to Dr. Eckenhoff each story shares a common thread: “Everybody has some kind of change they notice compared to before their surgery and it’s in multiple domains. For some, it’s sensory. For others, it’s word finding and memory or executive function. They have trouble figuring out crossword puzzles and things like that, when they had no problem before the operation.” It’s well accepted that cognitive ability can be affected after surgery, typically resolving within 30 days of the operation. “In Russell’s case, it persisted for over a decade. Many of the stories I get are like that,” Dr. Eckenhoff says. “Cumulatively, these anecdotal stories add up to something compelling.”
Russell was determined to get answers. Two years after surgery, he had a brain MRI that showed nothing unusual, he wrote in his e-email to Dr. Eckenhoff. However, “an EEG performed the same day was abnormal and showed frequent left temporal sharp waves, which could be indicative of underlying cortical irritation.” Russell noted that four day-long neuropsychiatric exams from 2006 through 2013 showed stable cognition. “Only for the last exam was an IQ value calculated: 118,” he says, which he estimated to be roughly 20 points lower than before his 2002 surgery. But by then, Russell was 70 years old.
Would patients like Russell have experienced cognitive decline anyway due to the normal aging process or did the perioperative experience precipitate or accelerate it? Can patients be screened preoperatively for risk for delirium and cognitive impairment? What can be done preoperatively to reduce the risk of postoperative delirium and cognitive decline? These are some of the questions that will be addressed at the Brain Health Summit, cosponsored by ASA and AARP in Washington, D.C., on June 21–22, 2018. The invitation-only meeting of medical experts, government agencies and other interested non-profit groups will convene to discuss delayed cognitive recovery and postoperative delirium in elderly patients after surgery and anesthesia.
Brain Health Summit 2018 Addresses Clinical Improvement and Patient Safety
The Brain Health Summit will explore the assessment and identification of at-risk patients, evaluate the need for educational materials for patients and their health care providers to increase patient safety, and promote advocacy efforts to fund research regarding these complications. Overall, the Brain Health Summit 2018 has three goals:
Currently, advancing age and pre-existing cognitive impairment have been identified as the strongest risk factors for postoperative delirium and cognitive decline. The question remains: What more can be done? “We’re hoping to develop a brief psychometric screen we can give to patients 65 and older to help identify those at risk for postoperative delirium and cognitive impairment, so they can be targeted when effective interventions are available,” Dr. Eckenhoff states.
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