The happiness of your life depends upon the quality of your thoughts, therefore guard accordingly. – Marcus Aurelius
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:
- At least 2 measures of CAMCOG (Cambridge cognition score)
- 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
