Expert: Mary Gordon - 6/18/2008

Question
My father has alzheimers.He is in the early stages-don't know what one. He had surgery and was given anesthesia. The surgery was on Monday. On Tuesday he would have a normal conversation and then out of no where he would make no sense at all. The sentences would not be related and he didn't even notice. He wasn't this bad before the surgery. Can this be permanent?

Answer
Louise, what you are describing is EXTREMELY common, and no one is really sure exactly why it happens.

We had a similar experience. My mother in law was in the early stages and broke a hip while in a store (no fall, she just twisted and something went crack). She hadn't been formally diagnosed - in fact, dealing with the hip break caused a six month delay, since specialist appointments had to be cancelled and rescheduled during her convalescence. Anyway, she had to have surgery to install a plate in the hip.

Prior to surgery, she'd been living on her own, doing fine, driving her car, keeping up a social life, doing her housework, cooking and shopping, managing her money. Her only overt issues were short term memory (she was forgetful, but she was very much aware she was having problems with it). She'd also started having trouble with numbers (challenges balancing her cheque book on her own). However, on the whole, she was a little fluffy headed and vague, but 95% her routine old self.

Post surgery, she was loopy to the point that the hospital sent social workers to talk to us, because they would NOT believe that she'd had been fairly well prior to the surgery. The hospital thought we were lying and were in denial - and they thought she should go straight into a nursing home.  She didn't know where she was, she wasn't making a lot of sense. Her memory problems were very much exacerbated - she would have visitors and have NO idea they'd been there (i.e. if you asked her where the flowers came from or the nice card and gift, she would have no memory of the visit from a family member. She went to a rehab facility for a few weeks of physio, and she couldn't keep track of her medication or use a calendar. Over all, it was totally shocking to us.

Now, she did come around very slowly - I would say it took months, rather than weeks, for her to recover what ground she did recover. However, I don't think she ever came back quite to where she'd been before the anesthesia.

Because it can be so striking, and can have such a huge impact on quality of life, many people who have loved ones with more advanced Alzheimer's decide not to put them through surgery for many problems, figuring its better to preserve cognitive function and let other health issues lie.

At least some of it seems to be stress related. A person's deficits are going to be more obvious when their coping skills are being challenged - when they are in a strange place, out of their regular routines, undergoing painful or confusing treatments, surrounded by strangers. Being tired, upset or unwell is going to make their cognitive state seem worse.  He is away from his normal props, comforts and cues.

There is a phenomenon called post operative delirium or acute confusional state that is very common in the elderly, particularly in those with dementia brewing (diagnosed or not). It may just be that they have less redundant capacity left in their brains, and are just hanging in with their fingernails, so any set back will seem to have a major impact on cognition. What might make you and I woozy or confused for an hour or two, might make them seem "out of it" for days. If you do some searching on the web, you will find research that seems unsure if this is a chicken or egg kind of thing. Are they more confused because the anesthesia has unmasked their underlying brewing dementia? Or are they more confused because the anesthesia itself has done damage? Its also possible with elderly people that their bodies just aren't very efficient in clearing narcotic and other drugs from their systems, so they have high levels of anesthesia related medication in their system for days following surgery, where you or I would be fine in short order.

There is a longer term impairment syndrome called Post Operative Cognitive Decline.

Here is a good article about the subject
http://www.cja-jca.org/cgi/content/full/50/suppl_1/R12 and another one
http://www.sciencedaily.com/releases/2004/10/041027142708.htm

Hope this helps. I know this is very upsetting and difficult to see, but odds are good he will rebound at least somewhat.

The hardest part is seeing this as a portent for the future - but you can take away at least some useful lessons for what will lie ahead - plan for worst case, and then be pleasantly surprised if things progress slower than you anticipate. Having good plans you don't need to use as soon as you fear is much better than having no plans prepared, and being plunged into crisis at a stressful time.

Hang in and see how he does, he is likely to come around most of the way back in the coming weeks. He's lucky to have family involved and concerned.

Mary G.