Surgery and anaesthesia: risks and preparation

My father with dementia needs an operation. Can anaesthesia worsen dementia? How do we prepare for everything?

This is a legitimate and common concern. The honest answer: the main problem isn't anaesthesia 'wiping memory' — it's post-operative delirium, an acute confusion that people with dementia are at higher risk of developing.

What is known

Delirium (intense, fluctuating confusion, with drowsiness or agitation) is common after surgery in people with dementia. In most cases, it resolves within days, but it can accelerate decline — so the decision to operate should weigh benefit vs. risk, in an open conversation with the team.

Before surgery

• Tell everyone he has dementia — surgeon, anaesthetist, nursing staff. Ask if there are less invasive alternatives and discuss the type of anaesthesia (sometimes there are options).
• Bring a complete medication list and ask what to stop taking.
• Optimise his condition beforehand: hydration, sleep, identified glasses and hearing aids to go with him.
• If possible, ask for a family member to be present when he wakes up — a familiar face is the best antidote to confusion.

Afterwards

• Maximise family presence in the first few days; ensure glasses/hearing aids are worn; natural light during the day, calm at night.
• Monitor for signs of delirium and untreated pain (a major trigger — he may not verbalise it).
• At home, reinforce routine and be patient: cognitive recovery is slower than wound healing.

Sources: Alzheimer's Society (UK); NIA — National Institute on Aging (USA).