Anesthesia related cognitive decline, specifically dysnomia

Posted by pb50 @pb50, Jan 5 2:42pm

I am a 73yo woman who retired 18 mos ago.
Almost exactly a year later, a pulmonary nodule we had been following in annual lung screening CTs as it slowly increased from 6mm to 14mm over 4 years, and at that last size the pulmonologist and cardiothoracic surgeon determined it was time to remove it in a wedge resection if it proved benign, followed by lobectomy if malignant. While that determination was made I remained under anesthesia. So in my case, it was quite a while.

Since the surgery i have slowly become
Aware that I have a material decline in specific brain function. It’s not as if I have a global cognitive decline. I don’t seem to have decline in executive function for instance.
But I have significant dysnomia. Not just names of people - rather names of “things” - but it’s easier to describe as a word to reference anything that functions as a label or reference term. Like names of diseases or an object. Virtually anything.

I had meetings over last couple of days with a hand surgeon to discuss surgery for duypuytren contracture (I have RA) and I inquired whether it could be done under a local nerve block and we got into a discussion about anesthesia related cognitive issues. He said that it sometimes takes more than a year for “brain fog” to clear. I guess fog is a good term, for I have become relatively sedentary and withdrawn since the surgery.

Concurrently I find that as a 73 yo patient, I am discounted and some docs - not all thank goodness - show little effort to even appear engaged. I have found a couple of Docs
- the hand surgeon and a new oncologist - who will discuss it.
So in that context I’d like to ask if any of you are experiencing cognitive or personality issues following general anesthesia? Am I a population of One, or a member of a much larger population?

Interested in more discussions like this? Go to the Brain & Nervous System Support Group.

@SusanEllen66

@pb50 I went through that more than 2 years ago and was diagnosed with Mild Cognitive Impairment.
Now, I have moved on to Ataxia and dementia.
The neuropsychological test is exhausting. Four hours of all kinds of focused activity and work. I’m going through that again in May.

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Thanks for that insight. I gave up six vials of blood to confirm I don’t have any of the obscure reasons for cognitive impairment like neuro-syphillis or very low levels of specific vitamins. Next is the neuropsychiatric testing and some imaging.

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@SusanEllen66

@pb50 I went through that more than 2 years ago and was diagnosed with Mild Cognitive Impairment.
Now, I have moved on to Ataxia and dementia.
The neuropsychological test is exhausting. Four hours of all kinds of focused activity and work. I’m going through that again in May.

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Thanks for that insight. I gave up six vials of blood to confirm I don’t have any of the obscure reasons for cognitive impairment like neuro-syphillis or very low levels of specific vitamins. Next is the neuropsychiatric testing and some imaging.
Did you get any actionable insight from the testing you had done?

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@pb50

So I had a very positive meeting with the Neurologist this afternoon. He has ordered a lot of labs - they took six vials - and a brain MRI w/out contrast. The labs are different vitamin levels and such. See pic I attached. We will see if Medicare will allow but I will find a facility with a decent cash price if need be. He has also ordered neuropsychological testing.

He wants me to change to a Mediterranean diet and exercise more. I told him I would look for a chef or a Frozen entree that fits the bill but I don’t really cook. 🙄

The MRI and neuropsych testing will be the interesting things. He gave me the silly Alzheimer’s test and I couldn’t remember one item on the list they want you to remember. I think I did ok on the rest.

It’s a start.

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@pb50 Pam, this is great! I’m so relieved that the neurologist spent enough time with you to get a real sense of your concerns. Did the neurologist give you a Mini-Mental Exam or the Montréal Cognitive Assessment (MoCA)? These are both quick cognitive screeners but they are just that. A screening test to help figure out if more testing is warranted. Anyway, the MRI and neuropsych testing will be far more helpful in figuring out your cognitive changes that you describe so well here.

I’m so glad you have a plan. I’m going to look up the vitamins and minerals that you are tested for. Thank you for posting that.

What’s next? Working on the changes in your diet? I’ve done the same on the advice of nutritionists I have seen. It’s a challenge and one nutritionist advised me that if I’m about 80% compliant with the healthy diet I’m doing really well. That was encouraging as I tend to beat myself up if I “go off the rails” and eat something from the unhealthy list of foods.

What kind of exercise do you like to do?

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@naturegirl5

@pb50 Pam, this is great! I’m so relieved that the neurologist spent enough time with you to get a real sense of your concerns. Did the neurologist give you a Mini-Mental Exam or the Montréal Cognitive Assessment (MoCA)? These are both quick cognitive screeners but they are just that. A screening test to help figure out if more testing is warranted. Anyway, the MRI and neuropsych testing will be far more helpful in figuring out your cognitive changes that you describe so well here.

I’m so glad you have a plan. I’m going to look up the vitamins and minerals that you are tested for. Thank you for posting that.

What’s next? Working on the changes in your diet? I’ve done the same on the advice of nutritionists I have seen. It’s a challenge and one nutritionist advised me that if I’m about 80% compliant with the healthy diet I’m doing really well. That was encouraging as I tend to beat myself up if I “go off the rails” and eat something from the unhealthy list of foods.

What kind of exercise do you like to do?

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No .. I had the standard dementia screening - remember these items, draw a clock, draw the hands showing this time, some simple math word problems, etc. I’m pretty sure I passed that 🙂

The doc has a PA who administered the mini cognitive tests and high level history/chief concerns, and a med student who execute the time consuming pieces of medical history and drafted the visit notes and summary.

He is starting a monthly seminar-workshop for avoiding dementia and the first one is tomorrow afternoon and I’m going.

I don’t cook. I’m the queen of frozen entrees and take out. I can pretend I’m going to change but I won’t. So I need to find a Mediterranean restaurant I can
order takeout from.

Being proactive seems productive.

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@pb50

Thanks for that insight. I gave up six vials of blood to confirm I don’t have any of the obscure reasons for cognitive impairment like neuro-syphillis or very low levels of specific vitamins. Next is the neuropsychiatric testing and some imaging.
Did you get any actionable insight from the testing you had done?

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@pb50 I have a rare autoimmune disease (Polyarteritis Nodosa) that affects the blood flow. However, an MRA showed that the arteries going up to my brain are clear.
. My brain is not getting enough blood so it is dying in spots. There is nothing I can do about that. It’s like having micro-mini strokes in arteries that can not be seen without special instruments.
Nothing is available to reverse this.

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@SusanEllen66

@pb50 I have a rare autoimmune disease (Polyarteritis Nodosa) that affects the blood flow. However, an MRA showed that the arteries going up to my brain are clear.
. My brain is not getting enough blood so it is dying in spots. There is nothing I can do about that. It’s like having micro-mini strokes in arteries that can not be seen without special instruments.
Nothing is available to reverse this.

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I am so dismayed for you! I know it’s more common peripherally. Do you have it elsewhere?

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@naturegirl5 , I owe you a follow up. It did take a while to get in with the neuropsychologist but I completed their tests and her impression is that of mild neurocognitive disorder. I had some specific areas of memory and/or learning that were well below average and others where I was rated as superior. I am satisfied that the areas of deficiency were identified. The scale based on average seems flawed and I know they compared me to other subjects with technical skills and a degree. But…. In any event it’s directionally correct In terms of areas of dysfunction relative to others. That’s all that matters.

My brain MRI was clean. And I wanted to get in the U of W VA trial but because I have APOE 4, which carries a risk of brain bleed, and the underlying meds they use to pry open the blood brain barrier also has a risk of brain bleed, the two together introduce too much risk - and I’m therefore excluded. I’m really disinterested in available meds with a bunch of side effects that might delay the worst of it by six months. So. That’s where we are.
I am going to get a PET after I see the neurologist again the first week of May. Otherwise, I will continue to eat well, exercise more, and stay busy. I am also going to look for an MSW or such for some Talk therapy.
And on an unrelated note, the
Biopsy from the colposcopy was low grade Squamous, see you in a year.

Such drama! Hope you are well.

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@pb50
I had 3 different surgeries January 2022 through July 2023 and have noticed cognitive decline, worsening brain fog and depression plus personality changes. I am 54 years old and now not able to work due to my cognitive and physical challenges (have 3 degrees and was working in a mentally challenging job). I certainly wasn’t planning to stop working at this age (a single parent of a teenager with no child support or extended family). Unfortunately, older women are often dismissed and I have experienced disrespect and bias. They often just chalk everything up to hormones, menopause and depression/anxiety and throw you prescriptions for antidepressants rather than digging deeper on the source of the problems. When we notice changes, we should be taken seriously and listened to. It is hard to do when you are not feeling well. We shouldn’t have to fight so hard to get care needed. The healthcare system is broken and there is so much waste with limited positive outcomes. Most doctors (not all) are not preventative or proactive and seem to forget to treat patients to improve their overall quality of life. We are healthcare customers who pay a lot but are not treated as such and not getting what we are paying for.

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@dlydailyhope

@pb50
I had 3 different surgeries January 2022 through July 2023 and have noticed cognitive decline, worsening brain fog and depression plus personality changes. I am 54 years old and now not able to work due to my cognitive and physical challenges (have 3 degrees and was working in a mentally challenging job). I certainly wasn’t planning to stop working at this age (a single parent of a teenager with no child support or extended family). Unfortunately, older women are often dismissed and I have experienced disrespect and bias. They often just chalk everything up to hormones, menopause and depression/anxiety and throw you prescriptions for antidepressants rather than digging deeper on the source of the problems. When we notice changes, we should be taken seriously and listened to. It is hard to do when you are not feeling well. We shouldn’t have to fight so hard to get care needed. The healthcare system is broken and there is so much waste with limited positive outcomes. Most doctors (not all) are not preventative or proactive and seem to forget to treat patients to improve their overall quality of life. We are healthcare customers who pay a lot but are not treated as such and not getting what we are paying for.

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Your frustration is merited. I’ve been rather shocked and unprepared for a dismissive response from SOME docs once I reached 70 and was on Medicare. I’m pretty wired for self-advocacy. But such a chore it is!! I have found it is sometimes easier to find another doc and then abandon the frustrating one. .

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@dlydailyhope

@pb50
I had 3 different surgeries January 2022 through July 2023 and have noticed cognitive decline, worsening brain fog and depression plus personality changes. I am 54 years old and now not able to work due to my cognitive and physical challenges (have 3 degrees and was working in a mentally challenging job). I certainly wasn’t planning to stop working at this age (a single parent of a teenager with no child support or extended family). Unfortunately, older women are often dismissed and I have experienced disrespect and bias. They often just chalk everything up to hormones, menopause and depression/anxiety and throw you prescriptions for antidepressants rather than digging deeper on the source of the problems. When we notice changes, we should be taken seriously and listened to. It is hard to do when you are not feeling well. We shouldn’t have to fight so hard to get care needed. The healthcare system is broken and there is so much waste with limited positive outcomes. Most doctors (not all) are not preventative or proactive and seem to forget to treat patients to improve their overall quality of life. We are healthcare customers who pay a lot but are not treated as such and not getting what we are paying for.

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How are you doing? I thought of you today. I had a dream that i was in the hospital and my bed was in the center of the floor and the doctor’s offices were around me on a rotating floor - so they slowly circled me 🙂

They only knew how to describe anti depressants and could not understand why i wasn't happy in spite of lung cancer and alzheimers and RA. They kept chanting “she’s supposed to be happy” as they gave me different anti depressants. I think i need to add a shrink to my complement of docs 😂

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