Post-Operative Cognitive Dysfunction

post-cog

I’ve recently learned about a disorder I’ve never heard of, but which was clearly in evidence in someone I care about. I share the following with YFL readers in the hope that it may relieve some of the stress they’ll experience in caring for aging parents and other elderly relatives and friends.

Post-Operative Cognitive Dysfunction (POCD) is a not-atypical condition affecting elderly patients following major surgery. The patient displays no signs of dementia or other Alzheimer’s symptoms prior to surgery; afterwards, he or she is confused, incoherent, and presenting very much like an Alzheimer’s patient. The condition is sometimes referred to as “hospital delirium.” Approximately 10% of patients over 60 experience it; after age 80, it affects as many as one in three. It’s generally thought to be mainly a function of the mix of anesthesia and the highly psychoactive pain medications administered following surgery, and it’s usually temporary.

Unfortunately, that is not always the case. Sometimes the dementia persists and contributes to a general downward spiral in the patient. One aspect of this syndrome that surprised me when researching it is the suicidal ideation sometimes accompanies it. The patient may retain sufficient self-awareness — and moments of near-complete clarity — that make him aware he is not himself, that some essential part of himself has been lost. This awareness may cause the patient to sink into a deep depression that may present in suicidal ideation and speech.

As alarming as this may be to the patient’s loved ones, there is cause for hope. Major strides in antidepressant medications have been made recently; the judicial use of these — along with some kind of mild anti-anxiety meds — can contain or even eradicate these thoughts. It’s critically important that the doctor carefully follow the patient’s progress and watch for side effects, some of which can be particularly dangerous for elderly patients. Please see the links below for further information on POCD and related ailments. They may prove helpful should you suddenly find yourself encountering a family member or friend who is “not himself/herself” following an operation.

Best regards,

William

http://ceaccp.oxfordjournals.org/content/6/1/37.full

http://bja.oxfordjournals.org/content/103/suppl_1/i41.full

http://psychcentral.com/lib/depression-new-medications-on-the-horizon/0005794

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