For years I have watched both friends and family come out of surgeries complaining of severe mental fog that can last for weeks, or even months. For some, cognitive function is never the same. Sadly, I suspect many of my readers either have had this experience or know someone who has. The good news is that some doctors and hospitals are paying attention and trying to do something about it. When I heard about the program at UF Health Shands called PeCAN (Perioperative Cognitive Anesthesia Network) that focuses on prescreening patients 65 and over who have risk factors, I was intrigued. We all are familiar with pre-operative screening, but why don’t we routinely check brain health prior to major surgery? What if a patient already has preexisting signs of neurocognitive issues that can be exacerbated by anesthesia? What if they are on medications that elevate the risk of post-operative delirium?
This amazing program was founded by Dr. Catherine Price in 2017 and is a first-of-its kind clinic providing presurgical screening to patients with risk factors. Sometimes she and her team are the first to recognize underlying cognitive issues. The PeCAN team includes anesthesiologists, neuroscientists, neurologists, surgeons, biomedical engineers, and experts in AI (artificial intelligence). They are funded by the National Institute on Health and this unique program is now recognized as the nationwide model for other hospitals! The co-director, Dr. Patrick Tighe, an anesthesiologist, who I spoke with, is an avid believer in looking at brain health as an indicator for more successful outcomes after surgery. Having this kind of knowledge about a patient at risk allows both the surgeon and the anesthesiologist to choose a tailored option for a patient with the least cognitive impact. Doctors can choose lower doses of certain drugs during surgery, closely monitor depth of sedation during surgery, or safely advise you to suspend medications you are currently taking prior to surgery that could put you more at risk.
Dr. Price estimates that 20% of all seniors preparing for surgery have some type of preexisting cognitive impairment that elevates the risk for complications. Some patients may be taking an OTC medication such as Benadryl or Zyrtec, not to mention prescription drugs such as Xanax, Klonopin, or Prozac. (Believe me, there is a long list). If someone is experiencing any memory loss, depression, had Covid, has a history of strokes, sleep apnea, they are at a higher risk for cognitive complications, along with many other conditions.
Currently, UF Health Shands has what they call a Phase I screening through the pre-op anesthesia clinic for all patients of any age who may be at risk. If needed, they are referred for a Phase II evaluation at the PeCan Clinic. This involves a 30-minute brain “health assessment” with a series of questions that assess memory and brain function that will be compiled into a report used to inform your surgical team, your primary doctor and eventually, you.
I visited with Dr. Price this week, toured the clinic, and completed parts of Phase I and II of the brain assessment. Dr. Price gave me a high-tech pen equipped with a tiny camera that captures images at 80 times per second. She asked me to draw an analog clock by making a circle, adding numbers, and showing a specific time on my hand drawn clock. The good news for me personally is that my brain did a great job! But for some patients, Dr. Price and her team will analyze these images and learn a wealth of information about your brain and can determine if further cognitive testing and neuroimaging scans are needed.
Think of the power of this one simple test to help screen millions of seniors at risk! With 12.7 million Americans expected to have Alzheimer’s by 2050, we need to do all we can to prevent cognitive impairment. When I asked both Dr. Price and Dr. Tighe how long it would take before their approach was the norm in all hospitals, they said it could be up to twenty years! They both agreed that “empowered patients who are educated about pre-surgery best practices, will make the difference!” The PeCAN website is
Become a pro-active patient! Ask your hospital if they have a prescreening clinic? Have a conversation with your doctor before surgery and find out the safest option available to you. My advice is to do all you can to take care of the one brain we have!
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