Anesthesia and the Risk for Postoperative Cognitive Dysfunction

To protect your brain against cognitive decline, you might typically consider cultivating brain healthy habits such as continued learning to keep your mind sharp. Or you might focus on lifestyle factors like consuming a healthy whole-food diet, getting regular exercise, pursuing hobbies and interests, or ensuring you consistently get quality sleep.

You might also avoid potentially harmful behaviors such as excessive alcohol consumption or participating in high-risk sports activities like skiing or sky diving.  Here’s another, unexpected risk factor for cognitive impairment to consider: surgery.

That’s right, surgery. When you go under the knife and are anesthetized, you are putting your brain function at risk. This is especially true for senior populations. Research published in Clinical Interventions in Aging indicates that 25% of patients over 75 undergoing major surgery will experience significant cognitive decline—and half will suffer lasting brain damage, There’s even a name for this phenomenon: postoperative cognitive dysfunction, also called postoperative cognitive decline (POCD).

Here’s what you need to know about how “going under” affects your brain, and what you can do to protect against POCD.

ABOUT POSTOPERATIVE COGNITIVE DYSFUNCTION

Adverse impacts to the brain post-surgery is not exactly new. Evidence of what we call POCD today dates back to 1887 when the BMJ published a piece about cases of delirium following surgery and anesthesia. While separate conditions, researchers see a close relationship between postoperative delirium and POCD resulting from surgery and anesthesia.

Today, research has a much clearer understanding of postsurgical cognitive decline, although many questions remain. A patient is diagnosed with POCD when deficits are observed in one or more areas of cognition, such as attention, focus/concentration, executive function, memory, visuospatial ability, and psychomotor speed. This condition will usually develop over a period of more than a week or month and lasts for an extended period—sometimes permanently. The consequences can be great. Patients with POCD are at risk of losing their jobs, their independence, and their basic quality of life.

WHO IS AT RISK FOR POSTOPERATIVE COGNITIVE DYSFUNCTION?

Serious Implications for Seniors: Considering that there are more than 230 million operations performed using anesthesia worldwide each year, and seniors (over 65) make up a majority of those requiring surgeries, millions of elderly patients are potentially at risk.

Affects Young Children: POCD can affect young children as well. A study published in Pediatrics found that children who underwent general anesthesia under the age of 4 later showed lower IQ scores, diminished language comprehension, and lower gray matter volume in their brains.

Higher Incidence Among Cardiac Surgery Patients: While scientists are still struggling to understand why, there’s clearly a higher incidence of COPD among patients undergoing cardiac surgery. Cognitive decline lasting up to 6 months post-surgery occurs in 20–30% of patients undergoing cardiac surgery, and lasting POCD of 12 months or more occurs in 15–25% of cardiac patients, according to a 2019 review study.

Other Risk Factors: In addition to old age and cardiac disease being risk factors, those with pre-existing cognitive health issues, alcohol abuse, vascular disease, low level of education, and postsurgical complications are all at greater risk of developing POCD, studies have found.

Interestingly, the education level risk factor has to do with cognitive reserve, which is the term used for the known linkage between a lower education level and increased risk of cognitive impairment in older age. Those with more education have greater cognitive reserve and a more cognitively resilient post-surgery.

Diminished Blood Flow: A pre-and post-op SPECT study of patients who underwent coronary bypass surgery showed that 68% had diminished blood flow, which was linked to cognitive dysfunction—specifically, decreased verbal and visual memory six months later.

Of course, low blood flow is a risk factor for a number of brain health issues. Reduced blood flow on SPECT scans has been associated with depression, bipolar disorder, ADD/ADHD, and more. Decreased cerebral blood flow is the #1 brain imaging predictor that a person will develop Alzheimer’s disease.

WHAT CAUSES POSTSURGICAL COGNITIVE DECLINE?

Scientists are still trying to understand what factors into the cognitive decline that some patients experience after surgery with anesthesia.  Currently, experts believe that POCD is the result of the stress and inflammation triggered by surgery and anesthesia on sensitive, high-risk brains.

Major surgeries can unleash a firestorm of inflammation. The brain contains the largest density of inflammatory receptors in the body, which makes it especially vulnerable to the effects of inflammation. When there is neuroinflammation, sensitive regions can get damaged. Studies involving brain-imaging scans have shown that the hippocampus, which plays a key role in memory, had reduced volume in some patients with POCD.

WHAT YOU CAN DO TO AVOID POCD

If you are anticipating surgery, discuss your POCD concerns with your medical doctor.

A shorter duration of exposure to anesthesia can also diminish the risk of POCD, as can reduce exposure to certain medications.

Of course, one of the best things you can do is to develop brain-healthy habits before and after surgery, such as:

• Eat plenty of brain healthy foods, such as fruits, vegetables, lean proteins, and healthy fats.
• Avoid inflammatory foods such as refined carbohydrates, sugar, fried foods, and excessive alcohol.
• Ensure you get plenty of restorative sleep, which your brain needs to function optimally.
• Exercise regularly (only when you are able to post-surgery), especially brain-boosting exercise.
• Engage in some type of stress-reducing activity like meditation or yoga.
• Practice new learning to keep your brain strong.

What you do each day has a huge impact on your brain, and a strong brain is your best insurance against lasting post-surgical cognitive dysfunction.

Postoperative cognitive dysfunction and other brain health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.