1. < Brain & Nervous System

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 I guess fog is a good term, for I have become relatively sedentary and withdrawn since the surgery.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.

pb50 | @pb50 | Jan 7 11:57am
In reply to @naturegirl5 "@pb50 Pam, that’s been awhile so I’m wondering if you’d like to talk with an expert..." + (show)
@naturegirl5

@pb50 Pam, that’s been awhile so I’m wondering if you’d like to talk with an expert in this area. I can certainly sense your frustration and concern.

I don’t have a specific recommendation for an individual but perhaps a neuropsychologist? You know yourself well enough that you can describe your cognitive status before and after the surgery and then track your progress with neuropsychological testing. It could be challenge just getting in to see a neuropsychologist in the near future but it’s an idea if you want to see numbers and objective results that can be followed over time. The other thought I have is a neurologist who specializes in higher cognitive function. I think many neurologists with this expertise tend to be found at academic medical centers. For instance, there are neurologists with this expertise at Johns Hopkins. I copied a link for Dr. Argye Hillis because I knew her when she was a speech-language pathologist who later went into neurology. I’ve often thought what a great combination of skills she has for her patients. She practices at a Memory Disorders Clinic. I’m not suggesting you have a memory disorder. It’s just that many neurologists with this expertise often practice in these centers.

Argye Hillis, MD
— https://www.hopkinsmedicine.org/profiles/details/argye-hillis

Anyway, these are my thoughts. Feel free to write me a personal message on Mayo Clinic Connect.

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I have an appointment with a neurologist from Duke Health on Tuesday regarding another matter. But I intend to ask about a neuropsychologist or neuropsychiatrist referral for this. I will let you know his response. Again, many thanks for your guidance.

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mresnick664 | @mresnick664 | Jan 8 9:45am

I have wondered about this as well. I have had several surgeries and following have had trouble remembering things etc. Anyone else, and what is medical field saying?

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pb50 | @pb50 | Jan 8 12:25pm

I had opportunity with hand surgeon, new Oncologist, and Primary to discuss. All agree that post anesthesia cognitive dysfunction is a phenomenon that takes multiple forms. Generally speaking, outside post anesthesia delirium, an entirely different thing, what I am experiencing is fairly typical: onset a few weeks or months following surgery and persisting several months or even years. In my case it is Word Retrieval struggles. If I were to anthropomorphise it, I would say the word is behind a glass door - I can seen the shape of it, sometimes I can see the first letter. If I’m in a setting where I can relax the pressure to retrieve it, it will frequently come to me. But more frequently I pivot to synonyms.
I’m being candid that I’m experiencing a reaction to anesthesia and am optimistic it will clear.

I am going to request some neuropsychological testing to see what if any insight is produced.

Thks

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pb50 | @pb50 | Jan 8 3:05pm

@naturegirl53
Helen, I had my annual physical with my Primary this morning. We had a good discussion. He described a range of time to symptom onset, and the range of symptoms in terms
of how disruptive they may be. He considers mine a nuisance level and said it is unlikely that it would morph to something worse.

Tincture of time and patience is the prescription 🙂 of course he couldn’t miss the chance to say eat healthily, exercise and sleep well. Avoid alternates of consciousness.

Consult with Neuro Wednesday and I’m going to pitch for neuropsych testing.

Later!

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1 reply
Mentor
Helen, Volunteer Mentor | @naturegirl5 | Jan 8 7:55pm
In reply to @pb50 "@naturegirl53 Helen, I had my annual physical with my Primary this morning. We had a good..." + (show)
@pb50

@naturegirl53
Helen, I had my annual physical with my Primary this morning. We had a good discussion. He described a range of time to symptom onset, and the range of symptoms in terms
of how disruptive they may be. He considers mine a nuisance level and said it is unlikely that it would morph to something worse.

Tincture of time and patience is the prescription 🙂 of course he couldn’t miss the chance to say eat healthily, exercise and sleep well. Avoid alternates of consciousness.

Consult with Neuro Wednesday and I’m going to pitch for neuropsych testing.

Later!

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@pb50 Thank you for sharing the conversation you had with your primary care provider this morning. And of course he had to add the usual eat healthy, get exercise and plenty of sleep. So you will see the neurologist at Duke on Wednesday. Sounds like a good plan and I'm hoping you'll get a referral to neuropsych. Will you please let me know what happens at your Wednesday appointment?

Helen

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2 replies
pb50 | @pb50 | Jan 8 8:17pm
In reply to @naturegirl5 "@pb50 Thank you for sharing the conversation you had with your primary care provider this morning...." + (show)
@naturegirl5

@pb50 Thank you for sharing the conversation you had with your primary care provider this morning. And of course he had to add the usual eat healthy, get exercise and plenty of sleep. So you will see the neurologist at Duke on Wednesday. Sounds like a good plan and I'm hoping you'll get a referral to neuropsych. Will you please let me know what happens at your Wednesday appointment?

Helen

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Thanks. I will.

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1 reply
SusanEllen66 | @SusanEllen66 | Jan 9 9:07pm
In reply to @pb50 "Thanks. I will." + (show)
@pb50

Thanks. I will.

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@pb50 thanks for this very timely, for me, information.
I’m going through testing with my neurologist, and neuropsychologist and this Friday I get to see the doctor. They already told me that dementia has be noted, and I have Ataxia. That’s from Cerebellum atrophy.
On February 8th I’m having surgery on my left hand because the sagittal bands are damaged. That requires general anesthesia.
Based on what you have said I am in real trouble…

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1 reply
pb50 | @pb50 | Jan 10 6:05am
In reply to @SusanEllen66 "@pb50 thanks for this very timely, for me, information. I’m going through testing with my neurologist,..." + (show)
@SusanEllen66

@pb50 thanks for this very timely, for me, information.
I’m going through testing with my neurologist, and neuropsychologist and this Friday I get to see the doctor. They already told me that dementia has be noted, and I have Ataxia. That’s from Cerebellum atrophy.
On February 8th I’m having surgery on my left hand because the sagittal bands are damaged. That requires general anesthesia.
Based on what you have said I am in real trouble…

Jump to this post

I might suggest a very frank discussion with surgeon and anesthesiologist regarding existing cognitive status and an appeal to make their choices accordingly. I’m having hand surgery in the near future to correct Dupuytren’s and it will be done with twilight meds and a nerve block. So regional anesthesia not general. It’s worth asking.

REPLY
pb50 | @pb50 | Jan 10 4:00pm
In reply to @naturegirl5 "@pb50 Thank you for sharing the conversation you had with your primary care provider this morning...." + (show)
@naturegirl5

@pb50 Thank you for sharing the conversation you had with your primary care provider this morning. And of course he had to add the usual eat healthy, get exercise and plenty of sleep. So you will see the neurologist at Duke on Wednesday. Sounds like a good plan and I'm hoping you'll get a referral to neuropsych. Will you please let me know what happens at your Wednesday appointment?

Helen

Jump to this post

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.

REPLY
2 replies
SusanEllen66 | @SusanEllen66 | Jan 11 1:00am
In reply to @pb50 "So I had a very positive meeting with the Neurologist this afternoon. He has ordered a..." + (show)
@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.

Jump to this post

@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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