Post-operative Cognitive Dysfunction

Visit this link to my article on Brain Blogger to read a brief description of post-operative cognitive dysfunction (POCD). Here is a selection of what I wrote.

In the mid 1950s, Dr. Bedford reported on a number of older adults who exhibited cognitive problems (memory or planning or being able to sustain attention) following surgery where anesthesia was used. This effect is now called postoperative cognitive dysfunction (or decline; POCD). POCD typically lasts for a few months to a year with a small minority of patients exhibiting permanent decline. Studies about it were few at first, with most focusing on cognition following cardiac surgery. Over time and especially more recently, there has been an increase in research of POCD following non-cardiac surgeries (e.g., abdominal or orthopedic) as well as continued interest in POCD following cardiac surgery.

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20 Replies to “Post-operative Cognitive Dysfunction”

  1. My husband had mechanical valve replacement 3 months ago and still has very bad judgement when driving and just started staring off and crying about most anything?

  2. I’m sorry to hear that. From what we know from research, your husband’s judgment should hopefully improve with time – it is very rare to have lasting impairment beyond a year (and it can take that long to improve).

    With your husband’s staring spells and crying, I’d recommend talking to your primary care physician or a psychologist (or psychiatrist), if you have not already. It’s possible your husband is experiencing a depressive episode, or something like that, which could be affecting his judgment. It is important to talk with his physician.

  3. I had a brain tumor removed 5 years ago at age 51 and started having cognitive problems almost immediately. And I’m STILL having problems with memory and decision-making skills.
    I have memory loss and confusion and very short attention span.
    I try to keep active (in spurts) doing crossword puzzles, reading, etc., but it (POCD)has affected my whole lifestyle.

  4. The memory loss and confusion and short attention must be really hard to cope with. Doing puzzles and other things requiring sustained attention can help ‘train’ your brain and keep as much of your mental functioning as you can. Without my knowing where the tumor was located, it’s likely that the attention problems are at the root of your confusion and other memory loss. Removing brain tumors unfortunately is impossible to do without damaging some of the surrounding tissue. It’s unfortunate that your problems have persisted, just try to stay as active mentally and physically as you can – it will help.

  5. Any changes like that can be very concerning Cassa. However, because he is only about one month post-surgery, it is not unexpected that he is having some problems. With heart surgeries, up to 60% of patients experience cognitive declines for up to 6 months or a year. Some recover faster than others and a small percentage have lasting cognitive deficits. At this point, if you are very concerned you could talk to your doctor for reassurances but I’d give your husband more time. If he is still having problems at 6 months, then I’d start to talk to your doctor and/or seek out a neuropsychologist.

    I hope things improve with your husband.

  6. My fit, 59-year-old husband had a 4.5 hour mini-maze ablation procedure a month ago. His blood pressure is low, averaging 95/63, about 20 pts. lower than it was prior to the operation, and he’s been taken off all but a cholesterol-lowering medication. He’d anticipated catching up on his reading during his recovery, but even scanning the newspaper taxes him. His conversational skills have sharply declined. His time is spent sleeping with mouth wide open, watching TV and staring off into space. I’d joked that he’s more like an effigy than a husband, but now, after a month, I’m starting to be concerned.

  7. Thanks so much. I know you’re right in saying it’s too soon to be worried. The issue may be that we weren’t properly informed about possible post-op scenarios — parameters for “normal” during the recovery. I intend to share this observation with our medical provider, Kaiser.

  8. 6/9/10
    I have hip replacement surgery scheduled for 6/15/10, and I am very concerned about POCD. Have there been POCD studies since you wrote about it? Also, is there memory loss with POCD? I am 70 years old and am a high school teacher/coach. If I go through with the surgery, I would like to test myself before and after. If the “after” test shows POCD, I would like to periodically test myself. I am finding it difficult to find tests for this purpose. Do you have suggestions? Part of my concern is my mother has Alzhiemer’s, and when she had hip replacement surgery two years ago, she had a decline of cognitive skills. I test her once a week with reading names of people in her life, a 5-piece jigsaw puzzle, and three photos (of herself, me, and her other son), each of which are cut in half for her to try to push together. In other words, I had something concrete to go on. After a few weeks, she regained enough cognitive skills for me to say she got back to normal, for her, although these activities are not thorough enough for me to be sure. Enough about Mother. I’m wondering about the possibility of new studies coming out within the next year or so, which would prevent or bring down the % of decline of POCD. Is it possible to find out if studies are planned in the future?

  9. I am a 47 year old former Library Director. I am not sure from what That I have cognituion problems. I have PTSD from my previous job due to harrassment from a board member.
    I have a rare homoplasmic variant of Mitochindrial Disorder. I has a surgery from which I awaoke from asenthesia upset and disoriented in March 2009. My Neuropsychologist has done
    cognitive testing and I have about 20% loss in executive abilities. I continue to have staring spells with mouth open etc. MY question is will my cognition get better?

  10. I am 47yr old female who had a hysterectomy at age 39. Went into surgery with a perfect memory and came out with severe short term memory loss and cognitive impairment. I was told it should go away in a few days. Then I was told it would be a few weeks. Then it became years. It has slowly been getting better but I still have moderate impairment. 8 yrs later and I am at a loss. The short term memory loss is slightly better but the cognative is a huge struggle. What happened? There is no other reason for this problem. Could it be POCD?

  11. My Dad was diagnosed with stomach cancer. He had more than half of his stomach removed. The surgery had complications. That was 11 weeks ago. Now he is getting prep. for his chemo and radiation. He seems worse now than when he came home from the hospital. He cannot focus on anything for more than a few minutes. He has episodes where he completely forgets how to do simple tasks. He also moves more slowly and almost shuffles when he walks. The doctors have told us that the surgery was a success and that he is doing great…My Dad is 62 yrs. old and it is very upsetting to see him this way. The forgetfulness is causing him severe anxiety….and he has had panic attacks. This is new as he has never had them before. I had thought these may be attributed to the cancer. The doctors feel this is just anxiety. I am wondering…do his symptoms sound like P.O.C.D.? I have only just learned of this condition.

  12. I’m sorry to hear about your father’s cancer Kimmy. The forgetfulness could be any of what you said – anxiety, caused by the cancer and treatment, or POCD. If your father continues to have some forgetfulness that is interfering with his life or is distressing to him, I’d advise getting him a neuropsychological evaluation. The severe anxiety and panic attacks are treatable by psychologists with usually very good results. There are panic attack treatment protocols that have close to 90% success rates. If he has POCD, it can take up to a year for his cognition to return to normal. At the least, I’d recommend waiting until at least 6 months post-operation before a neuropsychological evaluation (although it might take a while to get in to see a neuropsychologist). He could certainly see someone sooner, especially about his anxiety.

    But yes, his anxiety could be causing the forgetfulness as could his cancer and treatment; it is not a simple answer. I hope things go well for you and your father.

  13. Sorry for the delayed reply Paul. Your comment unfortunately got lost in the shuffle somewhere.

    I, unfortunately, really cannot answer your question. Your cognition could improve but it also might not. Some people take up to a couple years to fully recover from surgeries. But, like you said, your cognition problems might not even be a result of the surgery.

    Keep seeing your neuropsychologist for assessments and/or a neurologist if you continue to have struggles. Often clinically, we will assess people 3-4 times to see any progression of cognitive changes either good or bad. That’s really the only way to get more solid answers. I’m sorry I cannot be more helpful than this but hang in there!

  14. I’m sorry to hear about your cognitive struggles amplexus. Yes, you could have POCD but it also might not be POCD especially because it is very rare for someone as young as you to have any cognitive problems after any surgery – that doesn’t mean it does not happen, it’s just very rare and unpredictable. Actually, the only thing we’ve found so far that reliably predicts who might develop POCD is age (people over 60 are at more risk). Even then, only a small portion of older adults develop POCD following major surgeries with very few of those having any lasting problems. Formal neuropsychological evaluation, if you haven’t had it, can be helpful in answering some of your questions. The surgery might have been a factor in your problems but it also might not be. I’m sorry I cannot give a more definitive answer than this but there are many things that can affect our cognitive abilities and a lengthy clinical interview and hours of testing often are required to start to understand what is going on.

  15. My brother had a hernia operation on 12/13/10. He is 61 years old, and I think was suffering from mild depression prior to surgury. He worked hard all of his life, he is a very organized person and has always been extremely frugal with his money. He is out of work on a workman comp. claim that is complicated. The problem is he is not dealing with the responsibilites of this, he is in jeopardy of losing his job, his income and his medical benefits. I have offered to help sort out the paperwork and find the resources to help him and he has no desire to do so. He doesn’t have a plan at all to counteract his situation. When I ask him questions, he doesn’t respond for a long time (dead silence), and his continuous response is “its too overwheming”. Also, he did say his job is making him pay for his full medical payments (their portion and his) , so made 2 medical payments of over $1,400. This is very out of character for him. Do you think he is suffering from POCD?

  16. My mother had very minor bunion surgery last year and within a day of the surgery she experienced significant memory loss as well as delusions. The initial disfunction lasted 3 months. Her GP thought she might have been allergic to the anesthesia due to a breathing complication from a previous surgery. We have thought this all along until recently. It has been 7 months since the last surgery and she still has “foggy days” every 4-6 weeks. They can last as a long as several hours to several days. She is scheduled to have a cardiac catheterization next week and I am terrified that she will go into another period of intense POCD. Are there any treatments? Have there been any cases of relapses with additional surgeries? Has the drug Versed used as a local anesthetic been shown to have this affect? Can you point me in the right direction for any help. I am finding nothing but resistance from her GP and the anesthesiologist.
    Thank you.

  17. My mother (age 83) had minor surgery (L4-5 spinal decompression). A person in their 40’s or 50’s would go home the next day and generally be fully recovered in 3-4 weeks.

    She had delirium for several days after the surgery and has had POCD ever since (6 months and counting).

    She had mild vascular dementia before surgery. She was nearly independent. Now she has Severe cognitive decline (stage 6 out of 7).

  18. I don’t quite fit in with the usual group that seems to have POCD. I am a 45 year old female with no current heart problems though I do have high cholesterol and a family history of heart disease. I also am experiencing POCD symptoms. In January 2011 I had lipo suction to my midsection. I do not know what type of anesthesia was used, except that I do know that is was giving thru an IV in my hand. The surgery and recovery went well, but I still had too much excess skin. In February 2012, I had a tummy tuck by a different doctor. This time the IV was in my arm and they put a mask on me before I was put out. Once again I do not know what type of anesthesia they used. I do know that after the surgery I noticed that I was having trouble with my memory. I would go to do something and forget what it was I was going to do. This isn’t really that uncommon, I have had that happen before but now it was happing most of the time. I have had incidents of turning on the stove and putting an empty pot on it and walking away and forgetting about it. I have turned on the facet and left it running, thank goodness my husband or kids have caught these things before they caused a problem. Recently I realized that I really don’t remember much from the past three months, I remember Christmas and before but not much since January. It is like I am always on auto pilot. I am going thru the motions of life but not really remembering them. Like when you drive to work and don’t really remember it. I have also noticed that I have trouble with my judgement when driving. And my attention span has really decreased. I have trouble focusing in on things and comprehension. It is getting really frustrating! Is there anything that I can do to help?

  19. Sorry to hear about your struggles. It’s not typical for someone young to have cognitive struggles after surgery. It’s possible that most of your cognitive symptoms are caused by the high anxiety and symptoms of depression you are experiencing. I’ve seen a number of people who were depressed and anxious after surgery. This was in part because of all the time spent recovering and not doing normal day-to-day activities but pain, stress, and other factors play a role. Returning to normal routines can help. I’d suggest meeting with a psychologist or other therapist about your anxiety and low mood (crying), if you aren’t already. While it will improve with time, speaking with a professional will help you. Once you get anxiety and depression under control, your cognitive struggles should go away. If they persist more than 6 months, it might be worth getting an appointment with a neuropsychologist for evaluation.

    A few things that might help in the meantime are getting enough sleep, cutting out caffeine if you use it (this can make anxiety symptoms worse), stopping smoking if you do, eating healthy foods, be as physically active as you can, be engaged socially, perform deep breathing/meditation exercises, and keep your brain active by reading, learning new things, or playing games.

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