Hello ! I read your question and understand your concern. It is common for dementia to aggravate after surgical interventions. I think you have done the best thing to stop tramadol. Elderly patients with dementia or Alzheimer’s disease may exhibit increased symptoms of confusion or agitation while taking tramadol. There are a lot of pain killers which can help in her situation . Regarding dementia I would like to know more about her treatments. There are different therapy like Cholinesterase inhibitors such as donepezil, galantamine, and rivastigmine. Memantine is another drug effective in Alzheimer but also other types of dementia . You can use antipsicotic too for agitation if needed, Hope to have been helpful! Best wishes, Dr. Abaz Quka