DIMENSIONS Spring 2000

QUESTIONS AND ANSWERS

by James B. Leverenz, M.D.

Q. My father had hip replacement surgery two years ago. Since the procedure he seems to be having more and more memory problems and he sometimes has trouble expressing himself. I'm worried that he may be getting Alzheimer's disease. Can stressful events like surgery trigger AD?

A. Those of us who treat AD patients have a number of stories of patients who presented with symptoms after a stressful event such as surgery. It is clear that patients with AD do not do as well in stressful circumstances such as illness and also with psychosocial stresses such as the death of a spouse or a move. At this point we suspect that the stressful event may make the early symptoms of AD more noticeable because the individual no longer has a reservoir of cognitive skills to fall back on. In addition, some stressors, such as the death of a spouse, create a situation in which a person's cognitive problems are more obvious because there is no caregiver now "covering up" or compensating for losses that have been developing for some time.

Several research groups, including our own at the UW ADRC, have tried to examine the influence of stress and stress hormones (such as cortisol) on brain function and brain cell loss. So far these studies suggest that stress can influence the chemistry of the brain, but not cell loss or Alzheimer's disease changes of the brain.

Thus, a stressful event early in the course of AD may bring out the symptoms a little earlier, but probably does not cause or trigger the disease. If your father's memory problems continue to be of concern, consult with your father's primary care physician. He will be able to assess your father, and find out whether his memory problems are minor or may indicate a more serious problem such as Alzheimer's disease or another dementia.


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