Case Studies

Patient Stories and Improvement Stories

The following real cases are typical cognitive outcomes for some of our older patients following anesthesia and surgery.

Case #1, 67-year-old woman:

“I had surgery under general anesthesia about 10 days ago, and my higher-order thinking skills are only slowly returning. I am a patent attorney, among other professional skills, and need to return to a high level of mental functioning.”

Comment:
This is an example of what used to be termed postoperative cognitive dysfunction (“POCD”), but a new nomenclature effort has recently been completed, that will provide a new diagnostic term for this short-term form of cognitive dysfunction. Stay tuned!

Case #2, 63-year-old woman:

“The past two times I have had anesthesia I have had post-op cognitive problems. The first time, I could hardly speak. It took great concentration to say anything, although my thought process seemed to be working. It wore off within about 12 hours. I was age 40. The second time was 7 years ago, and I was 56. This time it took about 3 months to wear off, and it wore off gradually. I am still more forgetful than before that surgery, and I still sometimes lose my thoughts mid-sentence, but I can speak without having to think of each syllable or word. In the beginning I would lose my train of thought in the middle of a sentence just thinking of how to say each word.”

Comment:
Again, this would have been lumped under the term, “POCD,” but because of a new nomenclature effort to align these post-operative cognitive syndromes with cognitive decline in the larger community, a new, more specific term will be attached. Stay tuned!

Case #3, 78-year-old woman:

Living independently at home, she falls and sustains a hip fracture. Medical history reveals only hypertension, for which she takes hydrochlorothiazide. Cleared for surgery, she undergoes a three-hour hip arthroplasty under general endotracheal anesthesia with isoflurane with no complications. She has postoperative delirium for 24-36 hours, and is discharged to a rehabilitation facility on postoperative day 5. Rehab is complicated by depression, forgetfulness and inattention. Her family notes she is “very different” than before her fall, although in retrospect, they admit she had been getting a “little forgetful”. Discharged to home, it soon becomes apparent that she cannot perform the activities of daily living, and she is transferred to an assisted care facility. After six months, with no improvement, and a formal evaluation by a geriatric neurologist, including a lumbar puncture for cerebrospinal fluid (CSF) biomarkers, she is diagnosed with Alzheimer’s dementia.

Comment:
Again, this would also have been lumped under the term, “POCD,” but as a result of a new nomenclature effort to align these postoperative cognitive syndromes with cognitive decline in the larger community, a new, more specific term will be attached. Stay tuned!