I have had a number of clients who have sought out advice after coronary artery by-pass surgery. They, their spouse, or their children often report that everything was fine mentally until after the surgery. I often see these clients within the first year after surgery. The concern is always the same. Mom, dad, my husband or my wife has physically recovered from the surgery but now has memory problems they did not have prior to the surgery.

A recent study (Journal of Behavior Medicine, 2012, 35, 557-568) provided memory training to patients recovering from coronary artery by-pass surgery. They assessed cognition by neuropsychological evaluation one week, one month, three months, and four months after surgery. 65% of patients displayed memory deficits one month after surgery and 41% continued to have deficits after 4 weeks. Memory training focused on use of external memory support (a specific application of the One Minute Rule) and attention training (computer speed games) provided between six and eight weeks after surgery.

The study group consisted of 44 participants (all had Mini-Mental State scores above 24 – above the cut off for dementia) who were randomly assigned to either a treatment or a control group. Each participant underwent 8 training sessions of 50 minutes duration. Those who completed the training showed significant enhancement of memory as well as faster reaction times on an attentional test than did those who received no training.

Although this study addressed cognitive decline after heart surgery as this is an especially high-risk group, the issue of cognitive decline is not restricted to heart surgery. The risk is present after any surgery. Estimates are that postoperative cognitive decline occurs in 35% of those under 40, 56% of those 40-59, and 69% of those 60 and older at one week after surgery. By three months the rates decline to about 7% in those under 40, 13% in those 40-59, and 24% of those 60 and older.

Other risk factors include cardiopulmonary bypass surgery, duration of anesthesia, respiratory complications, infection, history of alcohol abuse, and a second surgery. Heart surgery produces greater risk for produce postoperative cognitive decline at one week after surgery but is no different from other surgeries (e.g., hip replacement, knee replacement) at three months. Hip or knee replacement produces similar rates of postoperative cognitive decline with either regional or general anesthesia.

The point is that adding memory training as an essential component for all post-surgery rehabilitation can at least partly mitigate the risk of cognitive problems after surgery. The training should probably start about two to four weeks after surgery (to give some time for post-operative delirium to clear). The training focuses on practical techniques and enhancing alertness. A few sessions can be very effective and may reduce the long-term outcome after surgery for all of us “elders.”