One of my Direct Access members is an anesthesiologist, and I recently asked her to share some information about the relationship between anesthesia and cognitive decline. She provided a very through response that I’m sharing with you:
I’ve researched the latest articles on this subject and have provided an overview of what is known to date.
Aging causes changes in our brains leading to decreased cognitive reserve, susceptibility to the stress response associated with anesthesia and surgery, and increased risk of cognitive decline post-operatively.
Mechanisms of action could be related to:
- Inflammation resulting from peri-operative stress
- Pre-existing vascular decline
- Acceleration of decline in patients previously undiagnosed
- Perhaps even choice of anesthetic agents used
A study published in JAMA in 2021 states that for patients age 65 and older as many as 65% experience post-operative delirium, and 10% may develop long-term decline after non-cardiac surgery.
As an anesthesiologist, I find this information heartbreaking for my patients who have no choice but to have anesthesia and surgery. Pre-disposing factors include:
- Age
- Already compromised cognitive function
- Invasiveness of the surgery
- Duration of surgery
- Need for ICU admission post-operatively.
There have been some studies done on full general anesthesia versus regional anesthesia (nerve blocks like spinal and epidural), and there is still an incidence of cognitive decline in both groups suggesting it isn’t just anesthesia as a contributing factor. Things like the stress and inflammatory response; a need for ongoing narcotic pain medication; being taken out of your normal environment where sleep is nearly impossible (hospital setting and especially the ICU setting) with 24-7 care ongoing with loud monitors, bright lights and emergency teams rushing to other patients’ bedsides; and whatever medication may be needed in the immediate post-operative period.
There is evidence that pre-operative cognitive preparation is statistically significant in mitigating post-operative cognitive decline. This includes increasing physical activity, smoking cessation, proper nutrition, optimized management of underlying medical problems like diabetes and high blood pressure, and pre-operative cognitive stimulation … ”cognitive pre-habilitation.” This helped even at 30 days post-operatively.
Other considerations would be for your anesthesia provider to NOT use benzodiazepines (like Valium and Versed), anti-psychotic drugs, centrally acting anti-cholinergic drugs and phenothiazines (like compazine used to treat nausea).
It is important to recognize that you can do things before your surgery to make the risk of post-operative decline less likely. Speak with your anesthesia provider in advance to discuss drugs you don’t want that might contribute to cognitive decline post-op.
Angela Chapman is a Bredesen ReCODE Practitioner, Functional Diagnostic Nutrition Practitioner and Functional Health Educator. If you’re searching for practical ways to protect your brain health and avoid Alzheimer’s disease, her Sunday email is a great resource for you.