Cognitive Impairment & Surgery

Older patients with neurodegenerative disease quite often need surgery for reasons unrelated to their cognitive problems. Both the hospital and surgical environments can be challenging for patients, but with some planning, these difficulties can be minimized. The suggestions that follow are not all inclusive, and we suggest discussing suggestions your physician/s may have prior to any surgical procedure.

You can also print out this Bilingual Hospital Checklist for Families. It is written in English and Chinese.

Prior to Surgery

  1. Review all medications with the prescribing physician and discontinue or “hold” temporarily all medications not required to maintain continued health. Discuss the continued use of aspirin, ibuprofen, naproxen and any anti-clotting drugs such as warfarin (Coumadin®).
  2. Discontinue or “hold” all herbal or nutritional supplements one week prior to surgery. Vitamins, such as multivitamins are usually okay to continue. Discuss other vitamins or mineral supplements with your doctor/s.
  3. Monitor for adequate hydration.
  4. Monitor for and treat, if necessary, constipation.
  5. Monitor for and treat, if necessary, dry skin.
  6. Be sure earwax is removed and the ear canals are clear.
  7. Achieve adequate pain control during the week prior to surgery.
  8. Estimate kidney function, so if necessary drugs that are removed from the body via the kidney can be closely monitored.
  9. Where general surgery is considered, discontinue “Alzheimer’s drugs" (like Aricept®) days before the surgery to avoid drug-drug interactions with some drugs required to relax skeletal muscles during certain types of surgery.

Before and After Surgery

  • Ask doctors to administer, if possible, sedatives and pre-operative medications at the “low end of the dose range.” Elderly brains are more “sensitive to these drugs.”
  • Avoid or minimize the use of all anticholinergic drugs. Elderly brains are more “sensitive to these drugs.”
  • Adequate pain control is important in reducing agitation. Discuss how pain will be managed with the doctor.
  • Sleep is important; discuss how sleep will, if necessary, be managed during the hospital stay.
  • If possible, avoid Valium®-like drugs (benzodiazepines); if Ativan® (lorazepam) is prescribed the dose should be no more than one-half the usual adult dose.
  • Orientation activities, soothing music, massage all may be helpful, but the amount of stimulation required will vary from person to person.

These suggestions are not all-inclusive, and we suggest discussing suggestions your physician/s may have prior to any surgical procedure.