Beware of Post-Operative Cognitive Dysfunction

Pati Bedwell, an elder care coordinator at Takacs McGinnis Elder Care Law, a Life Care Planning Law Firm in suburban Nashville, Tennessee, found out about POCD when it happened to her mother. It was a routine colonoscopy, but Pati’s mother was given a new medication with her anesthesia. “Mom jokingly told the nurse she wanted something so she’d forget she was there,” remembers Pati. “The nurse told Mom that the medication would help wipe her short-term memory, so she probably wouldn’t remember much of anything of the procedure. That sounded good to Mom.”

Pati’s mother had the colonoscopy. Everything seemed fine. But it wasn’t.

When she went to the surgeon for her first post-op visit, Pati’s mother told the doctor that she had been noticing problems with her memory and a sense of sluggishness. “Mom had always been very sensitive to medications and if there was a side effect, she would get,” Pati notes. “Mom was also really in tune with her body and knew almost right away that something wasn’t quite right. The surgeon told her that this sluggishness was due to the anesthesia and that it would work its way out of her system in a month or so.”

Four weeks later, when Pati’s mom went back to see the doctor, things weren’t any better. In fact, Pati’s father told the doctor that his wife’s memory loss was worsening instead of improving. Again, the doctor told them to give it time. Ultimately, by the time the anesthesia had “worked” its way out of her system, Pati’s mother’s memory had so many holes in it that they couldn’t be filled.

“We were told that mom had dementia and that it wasn’t related to the anesthesia,” remembers Pati. “But I was there. I saw it happen. I knew her before the colonoscopy and I knew her after, and she was never the same.  I lost my mom that day, only she didn’t die. We got to watch her fade away for nearly three years. It was the POCD.”

Pati didn’t know much about POCD before it happened to her mom, but it affects a substantial number of older adults after surgery. Most patients are not told of the post-surgical risk of POCD during the process of informed consent. But they should be.

POCD can involve subtle, difficult-to-recognize symptoms that develop days to weeks after surgery. Some patients with POCD experience memory problems; others have difficulty multitasking, learning new things, following multistep procedures or setting priorities.

Most of the time, POCD is temporary and patients get better in several months. But sometimes — how often hasn’t been determined — the condition lasts up to a year or longer. In Pati’s mom’s case, the condition was permanent and may have contributed to the onset of her dementia.

Pati’s mom’s story just goes to prove that when you’re caring for elderly loved ones, you must be prepared be their advocate. “Ask questions and don’t be afraid to irritate the doctors,” Pati advises. “Sometimes that means putting the boxing gloves on. The last time Dad had surgery, I nearly got into a yelling match with the anesthesiologist who kept badgering us because Dad wouldn’t allow the drug that had caused Mom’s POCD to be used. Fortunately, we won that argument—but only because we persisted.”