What surgical patients should know about delirium

In particular, “sleep is critical because that's when junk and waste from the day are removed from the brain through the glymphatic system,” says E. Wesley Ely, M.D., codirector of the

Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center at Vanderbilt University in Nashville, Tennessee. Besides being important for overall cognitive function, getting

sufficient sleep also may help you stay better-oriented to your surroundings and be less susceptible to becoming confused while you're at the hospital. Meanwhile, to improve mental

agility, it may help to engage in cognitively challenging activities — such as doing crossword puzzles, word puzzles and Sudoku, or playing backgammon, Ely says. In other words, keep your

brain active to help yourself stay sharp and alert. Before having surgery, spend time reviewing your medication protocol — including any over-the-counter drugs and dietary supplements you

take — with your physician “to make sure there's nothing onboard that increases the risk for delirium or other cognitive disorders,” Eckenhoff says. “Something doctors often give with a

knee-jerk reflex is Benadryl, but we need to be careful with it for older patients.” Indeed, before having surgery, your doctor may advise you to avoid taking certain antihistamines,

sedatives, narcotics, benzodiazepines, anticholinergics and other psychoactive drugs that can harm sleep and increase confusion. "Psychoactive medications increase the risk of delirium

when they're associated with the stress of a hospital stay,” Eckenhoff says. Moreover, there's a concern that “those drugs alter your brain's neurotransmitters, and when

neurotransmitters are out of balance, that's when you go into delirium,” Ely adds. But don't go off any prescribed medication without getting your doctor's OK. With any

medication you're taking, talk to your doctor about whether it's safe for you to continue taking it up until and through the hospitalization. In some instances, “if the regimen

gets altered, that may contribute to delirium,” says Ronald Petersen, M.D., director of the Mayo Clinic Alzheimer's Disease Research Center in Rochester, Minnesota.