Surgery, Anesthesia and Memory Loss

Summary:  After surgery, many people experience short-term delirium and/or longer-term cognitive decline.  Scientists are still studying how to prevent these problems.

Doctors, families and patients report that surgery seems to cause short-term delirium and/or longer term memory loss in some people.

In a recent Duke University study of 1064 patients undergoing major surgery (but not heart surgery), neuropsychological tests showed the following rates of post-operative cognitive dysfunction or POCD:

Age range                  Leaving hospital      3 Months After Surgery

18-39 year olds                 37%                                 6%     

40-59 year olds                 30%                                 6%

60 or older                         41%                               13%

Zhongcong Xie, M.D., Ph.D.

Even higher rates of POCD have been reported after heart surgery, but scientists still don't agree on how to measure these problems, or on whether the heart patients also had memory loss before their surgeries.

Dr. Zhongcong Xie, Assistant Professor at Massachusetts General Hospital and Harvard Medical School, is working with his colleagues to determine what causes POCD.

POCD seems to be worse among the elderly, but "the reason why age is a risk factor for POCD remains to be determined," Dr. Xie says.  In his lab, he and his colleagues are researching

possible additional risk factors, including:

• Isoflurane, an anesthetic
• Desflurane, an anesthetic, combined with low levels of oxygen during surgery
• Low levels of carbon dioxide during surgery.

Other researchers are examining whether low body temperature during surgery or inflammation could be to blame.

So, if you need surgery, are there any steps you can take to lower your risk of delirium or POCD?  Unfortunately, until there are more human studies, we just don't know.  "The findings in all of the studies in this area are important," says Dr. Xie.  "But I would advise caution in extrapolating these findings in test tubes and in animals to humans.  Much more research needs to be done before we can come to any conclusions."

Comments

[Gail Rae Hudson]

I've had a fear of this, on behalf of my mother, for some time. So far she's been lucky in not requiring surgery that needs general anesthetic. I suppose, at this point, being on Hospice and all, she won't be getting any surgeries. I can report that the last surgery my mother had that involved a general anesthetic was in 1973. It was a routine D&C that used to be done to women who were in that latter stages of menopause. Maybe one of the precautions people should take is investigating, prior to any surgery that isn't absolutely necessary, whether the possible risks are worth the benefits. In my mother's case I doubt that this particular surgery, which would be considered unnecessary now, did her any harm. At least, for many years harm didn't seem to be indicated. But, probably, at this point, the best approach would be, the less surgery, the better.

[Len Wheeler]

I recently had surgery on my knee - arthroscopic. I was only to be in 45 minutes but was in 90 minutes. Things were complicated after and there was major bleeding and swelling to my leg. I had to keep it elevated to avoid a DVT and Pulmonary embolism.

Since surgery my lady-friend has told me I forget things very often and can't remember conversations from the morning. I had a frontal lobe brain injury 12 years ago from a head-on car crash and was at the Brain Injury Clinic. Unfortunatly I went from patient to care giver when my wife got into a major accident and became an invalid. She eventually died, but I had no more treatments at the clinic.

I don't know if this is related to medication the hospital gave me and my worry is that I may have had a TIA.

Appreciate your opinion

[Mona Johnson]

Len,

I'm sorry to hear of your head injury, your wife's death and your knee surgery.

It sounds like your situation is complicated, and you might benefit from a visit to a memory disorder clinic or neurologist who can sort out what's going on.

I'm not sure where you live, but if there's an Alzheimer's Disease Research Center you can get to, that might be a good place to start. The National Institute on Aging has a list of these ADRCs at http://www.nia.nih.gov/Alzheimers/ResearchInformation/ResearchCenters/.

Take care and good luck,

Mona

[Jason Butler]

I have had over twenty surgeries the past four years, starting when I was nineteen until now, being 23. I had surgery for Ulcerative Colitis back in August of 2004, and numerous other ones to try and fix pelvic sepsis that developed from a j-pouch that was constructed then. I had my last surgery 9/17/08 where they gave me a permanent illeostomy. None of the other pouches worked. I find I have lost a lot of memories, people will reminisce to me about things we'd done and I simply can not recall the events. Some I can, but they're very vague. That's not to say I've lost all memories, by any means. I also find my cognitive abilities have decreased as well. I don't use any street drugs or drink alcohol. My doctors say it has nothing to do with the anesthesia, but I beg to differ. Could you please let me know if you think my reasoning holds any validity, or explain what you think might be going on, or refer me to someone who can? On a side note, if you need a research subject, I'm willing to be one! I appreciate your time and concern with this possible amnesic case of mine.

-Jason Butler

[Mona Johnson]

Jason,

Thanks for your interesting comment. I'm sorry to hear about your illness and surgeries!

I'm neither a scientist nor a doctor, so I'm not qualified to give you an opinion on your case. You might try to locate a memory clinic or Alzheimer's Disease Research Center (see above comment) near you to get an opinion. You might also search using PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed)to see who is published in this area.

There are a number of studies going on about this potential problem - see http://www.clinicaltrials.gov/ct2/results?term=anesthesia+cognitive for a list. At least in most cases, I think you have to be undergoing certain kinds of surgery to participate in a trial, so that's not very attractive.

Good luck!

Mona

[Myra]

I am 46 years old and had gallbladder surgery Aug of 2007. I’ve had Memory loss ever since. It has become slowly better, but some days I have a hard time having a conversation because I cannot remember words. I was offered a great job last spring that before the surgery I could have done in my sleep, But I knew I could not do it now. I am wondering how long this will go on for.

[Mona Johnson]

Myra,

I'm sorry to hear about your surgery and your memory loss. Have you talked to your doctor or made an appointment at a memory clinic to get to the bottom of this? You might have other health issues that contribute to your problem.

I hope you get better soon!

[michelle]

my name is michelle. im 16 yrs old and i just had surgery dec. 2nd. i have short-term memory loss and drs dont know if its permanent or temporary.

[Bev Fritz]

My mother had surgery a week ago and went into A-Fib in the recovery room. She was fine in recovery and that evening. The next morning her speech became slurred and she lost much memory - there was no evidence of stroke.
We were told this is common for elderly.

[Evoulla]

My Grandad is 80, and has gone in for a knee operation 4 days ago. To this day he has memory loss, very dis orientated and confused.

Is this normal & How long will this last for?

We are hoping that the drugs, anesthetic is causing this?!

It is very worrying for us all, as he was a fit and healthy man before the op, and now he is like this!!!

[Mona Johnson]

Evoulla,

Sorry, I'm not qualified to answer your questions. As this post suggests, researchers and doctors are still sorting through this problem.

I hope your grandfather is doing better now.

Mona

[cindy]

I am very much like Myra. I had my inflammed gallbladder taken out almost 2 months ago and my memory is foggy, I still can't recall even simple words in a conversation. It's embarassing. And I'm still sleeping a lot at times. This is a real concern for me because I'm a teacher and have to remember things all the time. Any help?

[Victoria Klups]

I am a 36 year old female.After a bothched abdominal hysterectomy, I needed an abdominal bladder repair surgery. Complications the day after the bladder repair surgery, I needed another abdominal ureter repair surgery. I did loose alot of blood (readings were 6)and needed a transfusion. I have barely any memory of the 6 day hospital stay, which is understandable. I am now 3 weeks postop, I am completely forgetful, I can not remember people that come over or call, and I loose hours in a day. I constantly call my better half, so he knows what I am doing, and where I am at. Why is this happening.

[Mehnaz]

My uncle, whom had surgery more than 5 years ago still can not function mentally after his surgery. The cancer was removed in time luckily but the surgery has left him with no-short term memory. Please help and share any research or information you can. He is young and has little children and a wife that still won't give up hope. Doctors said that it may have to do with the anesthesia and lack of oxygen during the surgery. Please let us know if there is anything we can do to help him in this situation.

Thanks

[Mona Johnson]

Victoria and Mehnaz,

Thanks for your comments. I'm sorry to hear about these problems. If I see any new information, I'll be sure to post it.

Mona

[Stacy]

My husband is 37 recently had knee surgury othoscopic and was in about 45 mins the surguery went fine no complications but he's been having memory loss and can't remember what he did or said at times and he occationally repeats things It's been about 3 weeks what should we do

[Mona Johnson]

Stacy,

I'm sorry to hear about your husband. I've not seen any information about what to do if you experience post-surgery memory loss, but will post any info I come across in the future. Perhaps your doctor has some suggestions...

Best wishes for your husband's speedy recovery!

Mona

[Harpy]

I definitely had bad cognitive problems after my surgery in January 2006, when I was 30. It was removal of teeth under general anaesthetic, I was under for about 45 minutes. I have discovered several things in the last year or so related to that, which are a bit worrying.

1. The drug Versed (midazolam) is routinely administered to people for all kinds of procedures. It is a powerful amnesiac and while most anaesthetists will tell you the effects are very short-term, you do find people who are more sensitive to it and it can have lasting effects. I got my doctor to write on my record never to administer this drug to me again.

2. If nitrous oxide is given, it can deplete B12 levels, causing deficiency symptoms (including cognitive ones) until the person consumes enough B12 to restore levels.

3. Early 2006 was, by my calculations, when my symptoms of pernicious anemia also started - probably not helped by the general anaesthetic. It took three years before I started receiving B12 injections. In the meantime I was extremely worried that I had developed early-onset dementia, as I had all the classic symptoms. However, because my serum B12 levels were just a little above the Officially Deficient level, my doctor simply told me to eat more meat. I did research on my own and asked for a holotranscobalamin test, which came back quite deficient, and very raised homocysteine, and with a note from the pathologist to check for antibodies. I turned out to have intrinsic factor antibodies. My doctor then insisted that one injection every three months is sufficient to treat autoimmune pernicious anemia. Again, being the stubborn and curious person I am, i did more research, and found that while there are few clinical trials, that the prominent medical researchers on B12 as well as the most educated lay researchers all recommended dosing by symptoms, not labs. This is because if you have no or impaired intrinsic factor, your ability to store and recycle B12 is severely limited. And younger people tend to have greater energy requirements, as well as greater muscle mass, thus requiring even more B12. I need 1 B12 injection a week to stay away from cognitive decline, neuropathy, and depression.

My conclusion from all that is that the reference ranges for vitamin B12 can only be a rough guideline at best when treating certain conditions, and that the lower limit of the reference range is far too low. I often wonder how many dementia, multiple sclerosis, depression, schizophrenia, etc diagnoses are really caused by not treating B12 deficiencies because of this. I've heard from other people with pernicious anemia that they have insisted their doctor start their elderly parent who has dementia on B12 injections, and find that they have significant improvements. I try not to be one of those people that evangelises their own 'miracle cure' but I do really wonder! :)

[Ally]

My mother had emergency surgery three weeks ago and has just been released from CCU after a bit of pneumonia. I've noticed that she is confused and forgetful. I'm hoping it's due to the surgery and she'll bounce back.
With so many people on this thread alone with various backgrounds and ages, I'm becoming increasingly shocked that this isn't a bigger concern. Actually, I'm angry that this isn't a bigger concern. Not sure on the stats but surgery over the course of a lifetime has to be a high probability. With an aging America and longer life spans, we have to be aware of what can happen so we can make informed decisions on surgery.
I never had my wisdom teeth removed and figured I'd have to do that soon enough. Now I'm not so sure. Do I want to take chances? My father has Alzheimer's so would I be at a higher risk? My mom has had several surgeries and was even in a coma for a week long before I was around. Does that have anything to do with this confusion? So many questions and no where near enough people working to find answers.

[Andrea Labrum]

Hello, I have read all of your comments and would like to tell you what happened to my 70 year old father 3 years ago. He was found to have bladder cancer and had non invasive surgery however the cancer came back and the consultant decided it would be best for my father to have a general anaesthetic so to avoid any discomfort. However after the operation my father started having panic attacks and had lost his short term memory. He was incredibly confused and this whole situation has distressed him and my mother immensely. My father has now got to have this operation again and our whole family are very concerned about this. He has been offered a spinal block/epidural but the doctor is worried about my fathers blood pressure during this procedure. Is there any advice or reassurance you could give me regarding this forthcoming operation.

[Mona Johnson]

Andrea,

I'm sorry to hear about your father. I wish I had some advice for you, but I'm not a medical professional, and I'm not sure scientists know much more about this problem than they did when I wrote this post.

I understand how difficult this is for you and your family, and hope your father recovers quickly.

Mona

[James]

Hi, interesting posts. I’m 45, physically fit but after emergency abdominal surgery (Laparotomy due to ruptured appendix), I noted cognitive changes. Firstly improved long term memory retrieval (remembered events in substantial detail from my college years), but also noted that short term memory had deteriorated, usually the memory of an immediate event just did not exist until the event had been noted to me (possible flawed retrieval?). Now, 6 months later, I don’t think there has been a recovery. The improved long term memory has diminished, but the short term memory has remained flawed. I do find that the process of memory seems to have adjusted. I now find that I am automatically forcing memory retention but if I don’t I can fall into having inefficient recall (the most recent was leaving the weekly shopping in the car park and than driving off only remembering the shopping when I opened the fridge an hour later).

[Sheila Gay]

I recently had knee replacement surgery in sept 09. I am now 46 , I had a femoral block and a spinal block as well as light sedation. I had never had a spinal until april for first knee surgery without any problems. After my knee replacement, the dr could not manage my pain, no matter what, it was at a 10 the whole 4 days in hospital. the minute my spinal wore off, my whole body except for my head has sporadically started lightning jerkin and got worse when I tried to sleep. This was immediate, yet never addressed. I am a nurse n am aware of what is goin on with my body. After goin home, this jerkin intensified, like 76 in a 37 min period, n I mean jerkin that I could kick a football for the 2 pts. Ortho neva heard of it, therefore did nothin. Did give me a muscle relaxer to try. Didnt work. Since comin home, I cant seem to finish a sentence even though I know what I want to say n can describe it, but can get the word to come out. After 6 wks got sent to neuro who couldnt believe neuro was never consulted in hospital. I had an EEG, EMG, I knew I didnt have epilepsy but was put on antiseizure meds for the jerkin. It is not helpin. Had electrolytes checked cuz I called anesthesia myself. They said it doesnt happen, I told them different. That it is rare after a spinal, very rare, My neuro has only seen 3 cases, but it does happen. My sister is a nurse n I just spent time with her n she burst into tears on the phone with my mom cuz I have a memory like an elephant. I forget nothing and have always prided myself on it. Now its been months, I still have jerkin, and memory loss. My hubby has been sleepin on couch so he can get some sleep and Im hangin by a thread. My neuro is wonderful. She has been doin alot for me to treat symptoms but here I am, a young woman, nurse out on comp cuz I got a patient his blanket that was stuck in corner of his bed a slip in a puddle on floor and banged knee into metal frame of bed. Im getting very depressed n crying alot but I will never get another spinal again. I didnt even have one with me kids. I would bet my nursing lic it was the spinal that did this and my neuro agrees. It has been a horrible ordeal. My 21 yr old daughter told me I got weird since comin home from hospital. She asks me to look up a number n text it to her at work and I text our own number. I paid some bills and mailed the electric bill back to myself. Its really awful and the PA from ortho keeps saying Ive never heard of SPINAL MYOCLONUS, which is my diagnosis. U would think he would look it up one of these times cuz although rare, it happens after having spinal surgery and I am proof. I live in upstate NY and my neuro wants to try 3 more meds n then send me to boston to Lahey Clinic. Has anyone been thru anything like this before?

[Sharon Rawson]

I am age 58 and after a serious fall down a flight of steps I had two orthopedic surgeries on my right wrist about 3 months apart. After the last surgery I have had acute short term memory recall issues. It isn't being "forgetfull" it's a total absence of any recall in my short term memory. After this surgery, while in recovery and after discharge my oxygen levels would fall whenever I talked or if I fell asleep. I also lost my ability to smell or taste. I had a period of about 3-4 days of delerium at home after this second surgery. It has been over a year now, and all the doctors seem baffeled. The most common diagnosis is anxiety....I only wish, at least that would have a targeted solution. On the lighter side, I have accidentally brushed my teeth with a&d cream and put powdered cheese in my coffee...I try not to focus on the negatives, however, I would like some answers and to know what to anticipate. I am simply searching my way through the internet and learning more than I though possible. Thanks for all your posts and for this site.

[Fiona Kirton]

Thankyou for all this information. I am 50 and have just had my third op for breast cancer in a year. Total 18.5 hours surgery. I was havinga good prognosis after a double mastectomy and reconstruction going to University to do another degree this Autumn. The trouble is I am having extreme problems with my memory. Given the choice I would still have taken the option of the surgery and I guess the only thing I can now do is maximise my nutrition Omega Oils, Curcummin and the like to give my memory the best support. However I may have to forget the degree now I know the meomeory loss is probably down to the aneasthetic.
Best Wishes
Fiona