What are the opinions regarding anesthesia and its effects on dementia?

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What are the opinions regarding anesthesia and its effects on dementia?

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My Mom is 87 and has a stone in her common bile duct. It has flared only once that we know of and it was short lived. They want to do a procedure to remove the stone but she would have to be put under general anesthesia. Do we leave it and risk problems later or do it and risk making dementia worse!

Alzheimer's & Dementia Care Decisions Cognitive Decline Medical Care

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I found that the side effect (increased dementia) was temporary with my Dad. For the first week it was very profound, but diminishing as the weeks went by.

I think he was back to were he started after about a month. It was sure not a fun month, but he did recover from it.

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Thank you that is comforting!

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If the procedure is done with small incisions he may not be under all that long and should recover better. A stone in the bile duct is serious. I would do it.

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With a stone you often have no choice if there is pain. With a stone without movement and periodic checks on growth, it can be benign until death and not need surgery.
As a nurse I OFTEN saw dementia after anesthesia. Only a few cases were new onset, sudden and lasting. Many dissipated with time. However some did NOT. There is much controversy about this in medicine with doctors denying it can happen and others seeing it actually happen in the elderly and not without frequency. To tell the truth, an elder in the hospital who has early stages of dementia can become very confused and discombobulated in hospital, and better on discharge.
I would act only if there is pain, danger, and problems, or problems that could occur emergently. Also ask about the surgeon's expectations for removal. A large incision is rare today. This is almost always done by endocopic, and some can now do it through the throat without anything invasive (UCSF able to do this some years ago, was teaching it at the time).
If this was diagnosed due to symptoms, such as nausea, vomitting, pain you really have very little choice.

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Different155, I remember when my Dad [90+] had bile duct surgery as it was making Dad quite ill. After the surgery he needed to go to Rehab for 21 days to regain his strength.

Note that with any surgery, even with much younger patients, every hour one is under with anesthesia, it will take one month for each hour to get rid of the brain fog.

You have to weight the pro and con with any type of surgery. If your Mom waits, what would be the risks, if any.

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You have no choice but to have the stone removed since both the stone and the general anesthesia can contribute to mental decline.

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This procedure is done through an endoscope through the mouth. No incisions but will be put completely asleep. GI doc says usually takes only about 10-20 minutes. Hoping the anesthesia will be propofol like for colonoscopy but don’t know that yet. The doc called the stone “a ticking time bomb” therefore we have decided to have it done.

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You're doing the best you can with what you know. Be prepared for hospital delirium and potential pneumonia. Please read to the end. Good news to be found there! Recently, MIL, 87 with bronchiectasis, had hip surgery (fractured femur, ORIF procedure). She was ambulatory and enjoyed living prior to surgery, and has shown only slight dementia. Some docs recommended hospice but said it was our call. She couldn't have general anesthesia because of lung disease, so we went with a spinal, she went to surgery, and we prayed. After the surgery, MIL had hospital delirium; threw things, was in a dream all the time. She could not self feed/drink at rehab or get therapy. MIL developed pneumonia around this time and was treated with Rosefin. Then, back at ALF, her O2 level dropped, and she had to be transported twice to the ER because her Raynaud's didn't allow the finger pulse oximeter to register more than 60. In the ER her 02 was 92 with the better oximeter. Since she had the low 02 drama, couldn't complete sentences, was sleeping all the time with a BiPap, having to be fed by us, we chose hospice to be done at the ALF. As caregivers for the last decade, it's a mercy that we only know the difficulty in hindsight. We were prepping for a funeral, when my hubby went to visit and feed her this last week. Nearly six weeks after surgery, MIL began to speak in complete sentences as before. She thought she might want to go to the ALF Valentine's lunch (which she did). She wanted a haircut and wanted to know where all her shoes were! She's ravenous and wants real food, not pureed. What a turnaround! It's as though she woke up! So, her stamina isn't quite what it used to be, but her will to live is back on display. She's a tough 85 pounder! We're going to have to talk with hospice and decide if we continue or make changes to her care plan. She wants to walk again, but one more fall would do her in. Always more decisions, but that comes with the responsibility. Prayers for you!

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There is documented evidence that patients with cognitive impairment will be Negatively effected by anesthesia. Are there other avenues to explore that may be helpful to your Mom?

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Tide, do you have any links handy on that evidence. If so I would like to read it. My mom doesn't have a stone like the OPs but is considering a surgery that will require anesthesia. I don't feel the surgery is necessary and I'm worried she will come out of it worse.

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I can’t source articles but from my personal experience with my mother, anesthesia definitely triggered an increase in my mom’s dementia.
She had 3 surgeries in the last 7 yrs of her life. First a mastectomy at 81- mom didn’t have dementia before or after this surgery.
At age 83 mom needed a double CABG. That was heavy duty for her. ICU, ventilator, 100%. Mom made it through this surgery with no change in her mental status.

When she fell & broke her hip at age 87, that surgery and anesthesia made her a totally different woman. She was never the same after this- couldn’t always remember who my brother nor I were, always confused.
By the time she passed she still couldn’t remember who we were. It was 2-2 1/2 yrs after the hip repair. Then she had to go to a SNF/NH where she was for 14 months before she passed.

Your mother needs this surgery. That stone needs to be removed or she can develop sepsis. I would go in knowing the risks and making preparations for where your mom will be cared for afterwards & realize her needs and care requirements will most likely increase.

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My dad had hernia surgery at around 80 years old just as his dementia was beginning. I noticed a definite increase in his dementia afterwords, much more repeating questions, and this didn’t improve over time, just got worse as he aged.

Dad ended up in memory care and broke a hip this past September. He’s now 89. It required a pretty simple repair surgery of about 20 minutes under anesthesia. I was pleasantly surprised that it didn’t seem to increase his dementia. However his dementia is still slowly increasing. I visit him just about every day. Yesterday he was getting me confused with his long dead brother. This is a new decline.

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Here is a link about anesthesia and dementia from the Alzheimer's Society in the United Kingdom:

https://www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/general-anaesthetics

If it's only flared once, why isn't the doctor considering high energy extracorporeal shock wave lithotripsy? Here's an article from the British Medical Journal "Treatment options for common bile duct stones": https://pmj.bmj.com/content/79/929/181.1

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That method is only good for stones in the urinary tract. Will not work for those in the biliary tract.

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Dear Different, you've decided to get it done (prob only real choice really). Short anaesthetic so fingers crossed should be fine.

I think it's the longer time/surgeries that seem to push folk along the dementia levels but I'm sure it varies a lot.

Best of luck. Remember delerium is tempory & so easily confused with dementia. Expect a few *off times* at the start & hopefully things return to normal.

Otherwise it is what is called adjusting to *the new normal*. Which you will do because you sound like an intelligent, caring person & you've got this. All the best.

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I'm in the same situation, Different155, just a different surgery. My mom has a polyp just inside her rectum that is causing increasing pain and some bleeding. Surgery has been recommended, but we are getting a second opinion next week to see if there are any other options available. My mom moved in with us 2 1/2 years ago and the neurologist told us she was just getting older and forgetful. I didn't know about anesthesia at that point so when she went in for cataract surgery 6 months later I was surprised at the change in her behavior. She was then diagnosed with first stage dementia and ALZ. She had a colonoscopy last month with "twilight anesthesia" and was assured by everyone it was safe, but she has had a significant decline in her cognitive abilities as well as her emotional stability in the past 4 weeks. Needless to say, I'm scared, too. I'm bracing for having to make the decision for surgery, since I don't really expect there to be any other option. I do hope the very best for you and your mom.

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I would try to avoid anesthesia like the plague. Leave it alone & it will eventually pass naturally. That’s my opinion. You can also get a second dr opinion.
hugs 🤗

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I agree 100%.

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Any anesthesia will have an adverse effect.
I would avoid it if at all possible.
If sh currently has no problems and the situation resolved on it's own previously I would opt for the leave it alone course of (in)action.
If there is a flare up I would opt for the least invasive method.

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Antibiotics can also cause decline so it is unclear a lot of times which caused the decline, anesthesia or antibiotic or stress?

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General anesthesia causes the blood pressure to drop which decreases the amount of oxygen to the brain. The risk is commensurate with the mental condition of the patient related to age and how long they're under the anesthesia.

Some antibiotics can reduce dementia since they eliminate the infection that's causing a temporary decline in the mental state. Don't let people talk you out of getting treated.

The author might look at changing the diet to see if it'll reduce or eliminate flare-up's.

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My husband has had the same issue. About 15 years ago, he had the same issue: passed a pancreatic stone through the common bile duct and left scarring, that increases over time. Recently he lost weight (from normal 160 lbs. down to 109, and had to be anesthetized to examine the bile ducts.
This was last year. Since then, he's been diagnosed with a stricture and temporary stent placed in the duct to stretch it. He's been anesthetized 4 times in the past year for internal exam for cancer (none), and replacement of temp stents. Dr. will not put in permanent one since there's no cancer (why is that?), so we "look forward" to 2 more procedures within the next two months. All this has produced anxiety. I agree with the guinea pig remark!
His dementia has been showing signs of both progressing and receding alternatively.
He's been declining physically and mentally for 14 years, but seems to rally for months at a time. He's 85, and keeps announcing he'll live 5 more years when he's feeling good (about once every two weeks). If so, that will be the death of me, his caretaker. I love him dearly, but I really need to outlive him to take care of him and then dispose of his thousands of books and tools so the kids don't have to, that he refuses to give up!

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My step father age 90 just had a stent put in his leg. Everything went well until it was time for him to go home, his blood pressure plummeted, scary he ended being there for an other 7 hours, they finally got his BP up. Me? I'd avoid unless it is a life threatening situation.

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If this stone isn't causing pain/discomfort, I would let this alone. "Don't trouble trouble," as my Chinese friends say. Yes, anesthesia can make dementia worse. Who needs that?? The time may come when the only way to keep your mother comfortable is to remove this, but for now, it doesn't seem worth the risks of surgery and anesthesia. Not to mention a possibly-difficult recovery. Surgeons want to solve all problems with surgery, we need to be advocates for those who can longer advocate in their own best interests. Good luck.

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My mom had pancreatitis May of 2018. She ended up having her gallbladder removed by laparoscopy. They tried to remove the stone but the procedure failed.
She was 89 at the time with moderate Alzheimers. My mom is in good physical health with no heart disease, diabetes, etc. She recovered physically very quickly from the surgery. The multiple anesthetics that she had for various procedures did worsen her Alzheimers symptoms for about 2-3 months. She will be 91 this month and slowly succumbing to Alzheimers.

I am a RN and well aware of the risks of anesthesia and I knew what might happen. I think you need to weigh your mom's physical health as well as the Alzheimers issues that she has.

My mom was only on Aricept at the time and her PCP added Namenda after the procedures and I think that helped her mental status recover.

My concerns where her passing another stone and getting another bout of pancreatitis and then there is the risk of peritonitis so we went for the surgery.

Good luck and blessings for you and your mom.

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My mother’s stone blocked her duct and went unnoticed at her nursing home for three weeks even though she complained of pain. The area turned red and she was sleepy. They Ran her to Henn County where she died a couple hours later of sepsis.

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My mom is 79 and has moderate dementia and we have decided not to do anything that requires anesthesia. I know she would not want steps taken to prolong her life so that she can have more years with dementia. I know to some folks that may sound horrible, but to many of us, there is a huge difference between "living" and "existing".

If it were me and mom had only had one short lived situation with the stone, I would not do the surgery.

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Depends on how her heart, lungs, liver and kidneys are doing. If those organs are fine, she'll do ok with anesthesia.

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This is a generalization that is quite unsafe to make - especially for people with compromised cognition - this lady is 87 and has dementia! Depending on the severity of dementia, even just being in an unfamiliar environment like hospital is likely to cause her anxiety, confusion and agitation. Layer the potential brain toxicity effects of a general anesthetic over that, and there are real reasons for strong caution!

Different155 is very wise to exercise such caution on her elderly mother's behalf - I agree with other responders - seek some other opinions and options for your Mum.

You are doing a great job, caring about and being sensitive to how this might affect your Mum. All the best to you, and your Mum, for the rest of her days to be comfortable.

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Any decent anesthesiologist will do their 'due diligence' on your mom prior to ANY surgery. (MY DIL is an anes. Dr., and they do NOT take their jobs lightly!) If they deem a patient too ill, too old, too compromised to handle the proposed surgery, they can and will opt to not do the anesthesia.

Now, that's not saying ANOTHER dr won't step in and do it, I just know my DIL said she had 'turned down' several patients that she felt, in her best medical opinion, were not good candidates for general anesthesia.

Having said that--barring any other procedure aside from surgery or playing the 'watch and wait' game could be an option.

My 90 yo mother was a surgery junkie. I cannot count the number of surgeries she's had--and a lot were absolutely NOT necessary. AT age 85 she was in the sugeons office begging for a 2nd hip replacement. The surgeon looked at her massive file and said "R, you are never going to have surgery ever again. You do not NEED a hip replacement (she was trying to get it done 'in case'). I'm firing you as a patient.' He was an old friend, so I'm sure it was done 'kindly' but she has miraculously gone 5 years w/o needing any surgeries, which hasn't been the case in 50 years.

If there is no rush, get a few more opinions. Maybe a spinal and light sedation would work better than GA? explore other options, before you make the leap to GA. It can be brutal on the elderly (and the not so elderly--I had my gallbladder out at age 39 and I have never been the same. I've had to have a few procedures and I am always simply terrified at the 'after effects' which for me, are being weepy and super depressed for months.)

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Anesthesia can exacerbate dementia. Post anesthesia dementia patients have had hallucinations and paranoia, in my experience. Anesthesia along with unfamiliar surroundings can really affect an older adult. I would ask if there are other alternatives.

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That would depend on the health of the patient. Consult with specialist and anesthesiologist, specifically asking about the risks.

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Can you get a second opinion on this? I feel in general anesthesia for the elderly is placing them at risk. My mom’s doctor has told her for years that she is not a candidate for any more surgeries of any kind.

With her being a patient with dementia that complicates it further. I don’t think I would risk it.

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When my husband first became sick, I read that anesthesia could effect dementia. As it became necessary, car accident, etc. I noticed this to be correct or a coincidence 3-4 times. What happened was, a decline in his behavior and abilities that he never regained. It was taking a step down each time. I would not take the chance unless it was really necessary.

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Update! My Mom had the procedure on Monday and did well. Yes, the anesthesia has increased her symptoms of dementia somewhat but hopeful she will return to her “new normal” in a few days! As it turns out it was very necessary as they found a mass as well as a stone. She now has stent to keep the duct open.

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There seems to be a lot out there on dealing with this problem. Get her back to being active, staying hydrated, having someone around to talk to and observe her state of mind, and avoid certain medicines that can exacerbate it.

https://www.healthinaging.org/tools-and-tips/ask-expert-prevention-and-treatment-post-operative-delirium

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Glad that she did well! Hope you are relieved!

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What are the opinions regarding anesthesia and its effects on dementia?

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