Sometimes elderly with declining mental ability seem to have lost a little more after general anesthesia...
I'm not a Doc but hear Docs talk about the fog...
Yes, that's a big concern. One of the times my father in-law was in for surgery, they said they were going to put in a stent without putting him under. Unfortunately, they could not, and they had to put him under. He was not the same afterward.
Of course, he was not the same before, either, but we were disappointed in that they assured us they wouldn't have to put him under, but ended up doing so.
However, he was fortunately still very easy to handle, and quite the agreeable dementia patient, so that was a blessing for my mother in-law.
On a funny note, in the hospital he thought the bed controller/call button was a slot machine, and was complaining that it wasn't paying out. Every time his wife left the room, he insisted she was down on another floor of the casino, was probably winning and didn't want him to know, and left him at this crummy machine.
He did enjoy his days at the casinos over the years.
