My LO with mid-stage Alzheimer’s just received an abnormal stool test reading. Is there a downside to the anesthesia for a colonoscopy?

My mom was diagnosed with colon cancer at 79. Her large intestines were completely blocked, so she had to have surgery. She had no symptoms of dementia or Alzheimers at the time. She came through surgery, the surgeon said he was 99% sure he got all the cancer cells. The oncologist advised chemo "just in case" there were any wayward cancer cells floating around. I advised my mom and dad against the chemo - knowing how rough it is even on the "young people". They both accused me of wanting my mom to die. They were of sound mind at the time, so they made the decision to get chemo. Fast forward, 1 chemo treatment and mom was in the hospital hallucinating that she was tied to a bed in a basement all alone, terrified and physically sick beyond belief. Since that day, it has been a downward spiral into Alzheimers. There is no proof that the chemo caused the Alzheimers, but nobody will ever convince me otherwise. I wish I would have fought harder against the chemo for her at the age of 79. I firmly believe that my mom would not be in the memory care where she needs to be now. That was 8 years ago. 3 years ago, my MIL was diagnosed with colon cancer, she had surgery. She was very secretive, so none of the kids were even told about this situation until after she had her first dose of chemo. And...1 dose of chemo and she passed away 1 week later, leaving us with my FIL with dementia that she very convincingly hid from all of us for idk how many years.
So, long story short - NO to colonoscopy, NO to chemo, NO to any life prolonging measures.

Personally I would not put him ... and you.. through the prep and the test.
And I have to be honest and ask this...
What would be your course of action if the test result showed that there was cancer.
Would you put him through surgery? Lots of reasons not to.
How would you and he deal with a colostomy if it came to that?
How would he tolerate Chemo and or radiation if it came to that?
How would any surgery and treatment IMPROVE his life.
It may extend his life but will it improve the quality of his life?
Given the abnormal results and the possibility of cancer I would opt to have a Hospice evaluation done to see if he would qualify for the great services that Hospice can provide.

Kartyjb: He should not undergo a colonoscopy as the prep for it is the hardest part.

My husband, when he was still diagnosed as Mild Cognitive Impairment (now Moderate), chose not to do some medical tests for his heart for two reasons. One, he did not want to lose any more memories, or at least quickly lose some memories, from the anesthesia. Two, he was not willing to undergo any heart surgery any way, so there was no sense in doing the tests.

If your husband could understand he may lose more memories, would he choose anesthesia anyway?

I think you have been given good advice from everyone here.

My 81 yo mom has mid-stage dementia as well. I am not doing any extra testing. She is pretty miserable with her life so I do not plan on doing anything to artificially extend her life. I believe, at this point of her life, in letting nature take it's course, while ensuring that she does not needlessly suffer any pain.

So sorry that hubby has dementia at this level at 74. I worry about that with my hubby and hope he doesn't take that path. With both our moms with dementia, I am kind of done with it already!

Best of luck.

Anesthesia for a colonoscopy is usually only "light sedation" which causes less post-anesthesia confusion than deep sedation.

MILWD has a spot on a kidney and a latent aneurysm in the brain. When they moved in with us 3.5 years ago, BEFORE she was diagnosed with mild cognitive decline but AFTER she had signed a DNR, we found new docs close to where they are now living. When we asked about even monitoring the kidney and aneurysm, their primary RIGHTLY asked if she would do chemo or surgery and then dialysis or organ donor surgery if something was progressing on the kidney. She said no, so why go look? Mom was 78yo then and able to know that she didn't want interventions. We're all trained to be PROACTIVE with our health, but as we age, we need to be proactive with palliative care and think clearly on whether a test should be done. Now, Mom is around stage 3-4 and Dad is stage 6ish. I'm SO glad that doctor was viewing the situation as a whole and pointed out to all of us that pivoting in HOW we care is sometimes needed.

Karty, I'm sure this is so hard taking care of your husband. My husband is 72, if God forbid this is my life in 2 years, I wouldnt do any cancer screenings on him. I know it's not what he would want.

And what if your husband had cancer, what then? Chemo on an Alzheimer's patient, would be horrible and would progress his Alzheimer's a lot.

It wouldnt be what I would want either.

Best of luck to you. Keep us posted

Colon cancer is one of the slowest growing cancers. If the person is your husband (74) and he is already in the mid stage of his ALZ, I would never attempt to give him a colonoscopy and any subsequent treatment. It's hard enough mentally and emotionally when you have all your mind. IMO it would be most merciful to leave it alone (and merciful for you, his caregiver).

May you receive wisdom and peace in your heart as you ponder this decision.

I would not put a person suffering from any type of Dementia thru a colonoscopy. There is no way they would understand what to do the day before. Its not just eating no food, I had to take 24 horse pills and drink loads of water. I threw up the water. Was not leaving my stomach as fast as it was going in. I had to be near a toilet because there was no "holding" it in. I had mine done in 2021 at age 72. I am down for another one at 80. They are not recommended after 75 because of perforation.

By the way, my test came up positive. It was false. I was told there may have been some blood from a fissure. Really, the test is suppose to test for cancer cells. Since colon cancer does not run in my family, I will not have a colonoscopy done again.

The twilight sleep anesthesia for a colonoscopy is not the point. The treatment for colon cancer, should he have it, is. My ex had stage 4 colon cancer in his 50s w/o Alzheimer's to deal with. The surgery, with full anesthesia, and the ensuing one year + of chemo treatments was so hard on him, I can't even tell you. He lost SO much weight, he was chronically sick and had to be cared for by my son and his wife in their home for a year, developed bad neuropathy in his feet (which he still has to this day 6 years later), fever and chills, and 100 other side effects too numerous to mention. If your LO with mid stage AD has cancer, do you plan to put him thru THAT?? Or immunotherapy which is even worse than chemo, to extend a life that's riddled with misery??

When my mother had dementia, I prayed daily for God to take her out of her misery. I did absolutely nothing to extend her life, considering it to be an act of cruelty.

Please think long and hard about subjecting a confused elder to the horrible PREP for a colonoscopy, number 1, which you will be cleaning up the results of, and then making the decisions for the outcome of the test! In my book, it's a hard no.

Yes, there is. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034231/

I opted out of a colonoscopy for my mom with mid/late dementia after a positive occult stool sample. It was probably caused by Xarelto (per ER physician) so the dosage was lowered.

She had a fall about a month later and CT showed a number of things where I just threw up my hands and thought a colonoscopy would've been pointless anyway.

I was able to talk to her about the colonoscopy suggestion by her primary and she did not want to go to the hospital again. She also absolutely did not like the explanation of the bowel prep needed for the procedure.

At this point you have to determine what you would do if they found something that required further invasive procedures to fix. Would you do it given where your LO is with their Alzheimer’s?

For individuals with mid-stage Alzheimer's disease, undergoing anesthesia for a colonoscopy can present several potential challenges and risks. Cognitive Impact, delirium risk, complications during recovery, medical comorbidities, challenges communicating pain to name a few.

Anesthesia, especially general anesthesia, can cause temporary or longer-lasting cognitive impairment. This is a particular concern for individuals with Alzheimer's, as their cognition is already compromised. The effects can include increased confusion, delirium, and a potential worsening of dementia symptoms.
Alzheimer's patients are at a higher risk for postoperative delirium causing confusion, disorientation, and agitation. Delirium can lead to a significant decline in functional abilities and may have a lasting impact if not permanent.
Individuals with Alzheimer's often have other medical conditions that can increase the risk of anesthesia-related complications such as cardiovascular issues, respiratory problems, and other age-related conditions which can complicate the anesthesia process and recovery.

Talk with your LO’s Dr.’s to see what other options are there and really think about the risk/benefits of the procedure. Is it really necessary given the overall prognosis and quality of life. Sometimes, less invasive diagnostic approaches might be appropriate.

Ultimately, the decision should be made in collaboration with your LO’s PCP, Neuro, gastro, cardio, pulmonologist and whatever other Dr.s are involved and you.

Best wishes

Any procedure has risks. These are best researched yourself and discussed with the doctor. In the case of colonoscopy there is often, in fact, a short class to watch. You will be asked to sign that you have read the risks and understand them. They would include a risk of anesthesia (which is very light and brief for this procedure). One of the greater risks is perforation of the bowel, leading to peritonitis and in some cases death if not caught at once.

You should discuss all risks with the MD.
You should research "risks of colonoscopy" online.
You should also understand what the treatments would entail should you come up with a diagnosis of cancer. If it is the wish of the elder or the family acting in his/her behalf not to treat any cancers that may occur, then there would be little sense in having such a test. The surgery for cancer IS long, and the anesthesia for it would come with considerable risk. Chemo is difficult to tolerate.

Good luck making this decision, and remember to discuss all tests with your doctor; if they have no time to discuss things with you then I would not proceed until they do so.

I think the bigger question you need to ask is that if he does have colon cancer are you going to treat it when your husband has mid-state alzheimer's? If you are not going to treat the cancer (if he has it) then there is no reason to put him through a colonoscopy.

Yes anesthesia usually Makes Dementia worse .