Risk of dementia after anaesthesia and surgery

Chen, Pin Liang; Yang, Chih Wen; Tseng, Yi Kuan; Sun, Wei‐Zen; Wang, Jane Ling; Wang, Shuu Jiun; Oyang, Yen Jen; Fuh, Jong Ling

doi:10.1192/bjp.bp.112.119610

Cited by 129 publications

(131 citation statements)

References 32 publications

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“…More studies have investigated associations of surgery or anaesthesia with either dementia 20, 21, 33, 34, 35, 36 or Alzheimer's disease 33, 37, 38, 39, 40. Several 20, 21, 38, 40 have reported increased risks for these outcomes, but several have not 33, 34, 35, 36, 39.…”

Section: Discussionmentioning

confidence: 99%

“…Several 20, 21, 38, 40 have reported increased risks for these outcomes, but several have not 33, 34, 35, 36, 39. Two very large Taiwanese studies 20, 21, both based on medical records, found an increased risk of dementia following surgery with anaesthesia, of various types 20. A large US study 40 found an increased risk of Alzheimer's disease for coronary artery bypass graft surgery compared with percutaneous transluminal coronary angioplasty.…”

Section: Discussionmentioning

confidence: 99%

“…But the authors commented on the few high‐quality studies and found no valid cohort studies. Also, some large studies, for example, the two Taiwanese studies 20, 21, have been reported since that meta‐analysis. Generally, it appears unreliable to base primary data on the recollections of elderly participants, especially those shortly to be diagnosed with mild cognitive impairment or dementia.…”

Section: Discussionmentioning

confidence: 99%

“…But those studies had until recently produced mixed results 19. However, two very large recent Taiwanese studies 20, 21 both found an increased risk of dementia following surgery with various types of anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

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Cognitive decline in the elderly after surgery and anaesthesia: results from the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort

et al. 2016

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SummaryConcerns have been raised about the effects on cognition of anaesthesia for surgery, especially in elderly people. We recorded cognitive decline in a cohort of 394 people (198 women) with median (IQR) age at recruitment of 72.6 (66.6–77.8) years, of whom 109 had moderate or major surgery during a median (IQR) follow‐up of 4.1 (2.0–7.6) years. Cognitive decline was more rapid in people who on recruitment were: older, p = 0.0003; male, p = 0.027; had worse cognition, p < 0.0001; or carried the ε4 allele of apoliprotein E (APOEε4), p = 0.008; and after an operation if cognitive impairment was already diagnosed, p = 0.0001. Cognitive decline appears to accelerate after surgery in elderly patients diagnosed with cognitive impairment, but not other elderly patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cognitive decline in the elderly after surgery and anaesthesia: results from the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort

et al. 2016

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“…Although the incidence of zygoma-and related orbital-floor fractures decreased over the years towards the turn of the millennium for road-vehicle-accident related causes in the overall population of countries with mandatory passive and active safety-devices in cars and mandatory helmet-duty when motorcycling [1], still zygomatripod and/or arch-fractures and related orbital-floor-fractures represent the most common trauma of facial bones representing a quarter of all cases, followed by generic orbital-floor-fractures [2] and are now increasing again in recent years by ever higher numbers of approach in accordance with specialists for internal medicine and anaesthesia [14], preventing Cranio-Maxillofacial (CMF) -surgeryinduced major general medical complications [15,16], which might lead to iatrogenic reduction of quality of life and possibly of life-time for the elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Treatment-assessment of Zygoma-tripod, -quadripod, -arch and Orbital floor Fractures in the Elderly Patient: Results of a Longitudinal Clinical Study of 20 years (1995-2015) with 1318 Patients in a General Traumatology-department and Evidence-based Treatm

Troedhan¹

2015

Int J Oral Craniofac Sci

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The ever growing population of elderly patients aged 70 years and onwards are prone to facial injuries caused by a general degrading medical and mental state. Main cause for zygoma-tripod, -quadripod, -arch and orbital floor fractures are falls, followed by traffic accidents and only to a small extent violence. Surgical reduction for these types of fractures is recommended but not correlated to the general medical and mental state of this patient-group. Aim of the study was to compare the outcomes of surgical treatment versus non-surgical observation.Between 1995 and 2014 a total of 1318 patients -hospitalized for isolated zygoma-and correlated fractures -were initially screened for cause of accident, pain, hyp/anaesthesia of the corresponding infraorbital nerve, mandible mobility, facial emphysema/haematoma and diplopia and then distributed into three different groups: no functional and/or cosmetic surgery indication (X), surgery indication but denied by internist and/or anaesthesist due to high general medical risks (Y) and surgery indication and released for surgery by internist/anaesthesist (Z). Follow up for each group was performed on day 5, 7 and 1 month after date of injury.Pain assessment revealed a significant higher pain-load for group Z on the 5 th and 7 th day after injury. Mandible mobility, facial emphysema/haematoma and diplopia improved significantly better in group X and Y on day 5, 7 and after 1 month compared to group Z. Hyp/anaesthesia of the corresponding infraorbital nerve improved generally but not significant between all three groups.The results of this study suggest that indication for closed or even more for open-reduction surgery of isolated midface-bone fractures should be applied very restrictive and only in accordance with specialists for internal medicine and anaesthesiology for elderly patients and non-surgical observation might lead to better results both for life-quality and remaining life-time from the patients point of view. Few studies were published recently investigating the incidence and causes of facial-bone-trauma and prevalence of zygoma-tripod, -quadripod, -arch and orbital floor-fractures in the growing elderly population of 70 years + in various parts of the world [6][7][8][9][10][11] but only isolated studies suggest therapy-guidelines for treatment modalities in this increasing patient-group with mostly general chronic-disease anamnesis [12,13] which should be based on a multidisciplinary

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Cognitive Decline Associated With Anesthesia and Surgery in Older Patients

Vacas

Cole

2021

JAMA

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In the last decade, the population aged 65 years and older increased by 34.2% in the US and now accounts for a disproportionate number of surgical procedures requiring anesthesia. Among these patients, aging causes a number of changes in the brain that may contribute to decreased cognitive reserve, susceptibility to the stresses of surgery and anesthesia, and increased risk of neurologic injury such as postoperative neurocognitive disorders (PNDs). 1 Postoperative neurocognitive disorders is an overarching term that includes postoperative delirium, an acute state of confusion and inattention; and postoperative cognitive dysfunction (POCD), a prolonged state of cognitive impairment that predominantly affects higher-level cognitive skills and memory. Delirium and POCD previously were considered distinct entities, but recent data suggest an underlying relationship between them for the patient whose brain may be vulnerable to cognitivedeclineafterthestressorsofsurgeryandanesthesia.Proposed potential mechanisms for postoperative neurocognitive decline are speculative but include neuroinflammation as a result of perioperative stress, vascular disorders, or the acceleration of neurocognitive decline in patients with a previously undiagnosed neurodegenerative disorder, such as preclinical dementia. According to a study of patients who underwent noncardiac surgery, covert stroke occurred in 7% of 1114 older patients(Ն65years)aftersurgeryandwasassociatedwithanincreased risk of postoperative delirium and long-term cognitive deficits. 2 Among patients aged 65 years and older, up to an estimated 65% experience delirium and 10% develop long-term cognitive decline after noncardiac surgery. 1 Complications associated with delirium include longer hospitalization, more days with mechanical ventilation, and functional decline. After discharge from the hospital, patients who develop postoperative delirium are at increased risk of worsening functional and psychological health, progressive cognitive decline, dementia, and death. Although not as extensively studied as delirium, POCD is associated with a decrease in quality of life, loss of function, and increased mortality.

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Risk of dementia after anaesthesia and surgery

Abstract: The results of our nationwide, population-based study suggest that patients who undergo anaesthesia and surgery may be at increased risk of dementia.

Cited by 129 publications

References 32 publications

Cognitive decline in the elderly after surgery and anaesthesia: results from the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort

Cognitive decline in the elderly after surgery and anaesthesia: results from the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort

Treatment-assessment of Zygoma-tripod, -quadripod, -arch and Orbital floor Fractures in the Elderly Patient: Results of a Longitudinal Clinical Study of 20 years (1995-2015) with 1318 Patients in a General Traumatology-department and Evidence-based Treatm

Cognitive Decline Associated With Anesthesia and Surgery in Older Patients

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