Is anaesthesia linked to cognitive decline?

The happiness of your life depends upon the quality of your thoughts, therefore guard accordingly. – Marcus Aurelius

Patel, D. et al. (2016), Cognitive decline in the elderly after surgery and anaesthesia: results from the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort. Anaesthesia, 71: 1144–1152. doi:10.1111/anae.13571

Background

The effects of anaesthesia/ surgery on the development of dementia are unknown

Aims

To assess factors influencing the effects of anaesthesia and surgery on the trajectory of cognitive decline with increasing age.

Method

  • Retrospective cohort study/ analysis of the OPTIMA database – (Oxford Project to investigate Memory & Ageing)
  • Identified patients recruited by OPTIMA between 1988-2008 (follow up until 2012)
    • Patients seen annually
    • Subject to various testing inc. CAMCOG score
    • Genotypes (APOEe4 allele)

Inclusion criteria:

  1. At least 2 measures of CAMCOG (Cambridge cognition score)
  2. Participated in at least 3 years follow up

Exclusion criteria: minor surgical procedures

Results

  • 394/982 OPTIMA patients meet the inclusion criteria (m»f)
  • 150/ 394 were diagnosed with cognitive impairment (ranged mild- probable Alzheimer`s)
  • Only 36/150 patients had surgical exposure (16/ 36- diagnosed with cognitive impairment before surgical exposure)
  • 10 patients excluded as surgery over 10yrs post recruitment

They concluded that Cognitive decline was more rapid in:

  • Patient older at recruitment
  • Male
  • Worse cognition at initiation
  • Allele APOEe4 +

Pros

Use of a database more cost-effective than repeatedly collective new data

Cons

Small sample size

Statistically complex –limits clinician understanding

Wrong measure – CAMCOG does not test functionality

Surgery & anaesthesia not separately analysed (e.g. regional vs general)

Summary by Dr Lola Oyewole

 

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