Question: My 81-year-old mother is scheduled for elective surgery next month, and I am concerned about the possible effects of the operation and anesthesia on her memory. I base this concern on the condition of my father-in-law who, after hip surgery, went into a nursing facility for rehabilitation and never came home because of chronic short-term memory loss. I have expressed my apprehension to my mother, but she has politely told me to mind my own business. Am I overly concerned?

Question: At 72, I am planning cosmetic surgery. I trust my doctor, and have thoroughly researched the procedure. The trouble is that I have been warned by several friends that I could wind up with memory problems as a result of the anesthetic. One acquaintance of mine, in fact, told me that her family starting noticing signs of dementia in her just a few months after her face lift. While looking my best is important to me, it’s not as crucial as remaining independent. My doctors won’t tell me one way or the other. How can I find out?

Answer: While we certainly don’t pretend to be physicians, we have been able to talk to several who we believe have led us in the right direction.

First of all, no one seems to disagree that the elderly are at much greater risk from the use of anesthetics than younger patients. The time for recovery is longer, and the chance of complications is more severe for older patients. In addition, there are a number of age-related changes in lung, kidney, and liver function that may directly result in decreases in drug metabolism in the elderly.

Second, physicians report that while it is not unexpected to see cognitive dysfunction -- sometimes quite significant -- in older persons up to several days after undergoing surgery, studies have not been able to segregate anesthesia from numerous other complex factors that accompany surgery. These risk factors include pain and pain management, the interaction of various medications, the stress that accompanies surgery, the disorientation that accompanies being away from familiar surroundings, and infection that sometimes sets in after an operation.

Physicians tell us that a condition known as delirium or “Acute Confusional State” is often seen in geriatric patients in a hospital setting, but mainly in those who already have some type of dementia. Acute Confusional State manifests itself not only in impaired memory, cognitive function, and perception, but also repetitive physical actions, like moving from side to side. Delirium may require a longer hospital stay and can be a potential contributing factor should dementia later develop.

To further complicate matters, issues of medications for post-operative pain management must be dealt with.

For these reasons, it is essential that the patient -- or a close family member -- provide an accurate medical history to the surgeon and anesthesiologist, including prior reactions to drugs and an up-to-date list of medications. The primary care physician should be called upon to provide prior medical history along with functional status and even allergies.

Obviously, elderly persons with mid-stage or later-stage dementia are more at risk than others.

Taking the NextStep: There is no question but that significant cognitive dysfunction has been found in elderly patients after surgery. And, in a small number of cases, anesthesia could have been associated to an unknown degree with longer-term cognitive disorder and the acceleration of senile dementia and/or Alzheimer’s disease; however, no one is clear about the effects of other risk factors that are also present.

While there appears to be no clear tie between anesthesia and the later development of dementia, we believe that living with a few wrinkles may be a better choice than the possible ramifications of elective surgery. The final decision, of course, lies with the patient and his/her physicians after a thorough review of medical records.