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Br J Anaesth. 2018 Aug;121(2):398-405. doi: 10.1016/j.bja.2018.05.060. Epub 2018 Jun 27.

Association between exposure to anaesthesia and surgery and long-term cognitive trajectories in older adults: report from the Mayo Clinic Study of Aging.

Author information

1
Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
2
Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
3
Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
4
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
5
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. Electronic address: sprung.juraj@mayo.edu.

Abstract

BACKGROUND:

The link between exposure to general anaesthesia and surgery (exposure) and cognitive decline in older adults is debated. We hypothesised that it is associated with cognitive decline.

METHODS:

We analysed the longitudinal cognitive function trajectory in a cohort of older adults. Models assessed the rate of change in cognition over time, and its association with exposure to anaesthesia and surgery. Analyses assessed whether exposure in the 20 yr before enrolment is associated with cognitive decline when compared with those unexposed, and whether post-enrolment exposure is associated with a change in cognition in those unexposed before enrolment.

RESULTS:

We included 1819 subjects with median (25th and 75th percentiles) follow-up of 5.1 (2.7-7.6) yr and 4 (3-6) cognitive assessments. Exposure in the previous 20 yr was associated with a greater negative slope compared with not exposed (slope: -0.077 vs -0.059; difference: -0.018; 95% confidence interval: -0.032, -0.003; P=0.015). Post-enrolment exposure in those previously unexposed was associated with a change in slope after exposure (slope: -0.100 vs -0.059 for post-exposure vs pre-exposure, respectively; difference: -0.041; 95% confidence interval: -0.074, -0.008; P=0.016). Cognitive impairment could be attributed to declines in memory and attention/executive cognitive domains.

CONCLUSIONS:

In older adults, exposure to general anaesthesia and surgery was associated with a subtle decline in cognitive z-scores. For an individual with no prior exposure and with exposure after enrolment, the decline in cognitive function over a 5 yr period after the exposure would be 0.2 standard deviations more than the expected decline as a result of ageing. This small cognitive decline could be meaningful for individuals with already low baseline cognition.

KEYWORDS:

cognitive ageing; cognitive domains; cognitive z-scores; general anaesthesia; older adults

PMID:
30032878
PMCID:
PMC6200109
DOI:
10.1016/j.bja.2018.05.060
[Indexed for MEDLINE]
Free PMC Article

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