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Cognitive evaluation can help doctors to anticipate possible post-operative risks

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More hospitals are testing the mental fitness of older patients for surgery in the middle of the proof that the trauma of an operation of an accelerated cognitive decline.

The evaluation of patients for memory and thinking problems can help doctors anticipate how patients tolerate the surgery and follow the instructions for maintenance as soon as they are at home. A cognitive assessment may also assist patients, families and caregivers decide whether you want to continue with an operation by giving more information about the possible risks.

Studies show as much as 81 percent of the patients who meet the criteria for dementia have never had an official diagnosis, and families can look at the symptoms of only natural age-related memory loss. Patients with dementia are at a higher risk for a complication known as postoperative delirium, and probably even worse surgical outcomes, longer hospital stays, functional decline and death.

Without a formal cognitive assessment, “we agree all of these people for the great activities that they cannot understand, and they may not be able to deal with what happens afterwards,” says Dr. Stephanie Rogers, a geriatrician at the University of California, San Francisco. UCSF, which began in 2014 to do pre-surgical cognitive testing on all patients in its heart failure clinic, is not yet behind the back with a number of operations after the patients were found to have significant cognitive decline.

The American College of Surgeons and the American Geriatrics Society recommend that hospitals assess a patient 65 for cognitive impairment as part of a preoperative evaluation. Stress, inflammation, pain, medication and anesthesia that is often associated with the surgery are particularly difficult for older patients.

Angel Guerrero, 78, had the surgery at UCSF in 2013 to manage his heart failure, allowing the heart muscle does not pump enough blood to meet the body’s needs. His family had already earlier noticed that some subtle hints of loss of memory—he would often forget where he put his keys and repeat the questions. But they didn’t think anything of it, because Mr. Guerrero still drove, shopped online and booked his own flights, says his daughter,Georgina Fox. During the pre-operative discussions about the risks and benefits, Mr. Guerroro memory problems were not clear, the family is not of them, and he did not receive a formal cognitive assessment.

Mr. Guerrero, the doctors surgically implanted a mechanical pump known as a left ventricular assist device, or LVAD, that helps a weakened heart pump blood. The device is powered by a battery is connected to the tube is placed outside the body, that regularly need to be charged. The site must also be kept clean to prevent infection.

Click for more from The Wall Street Journal.

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