Journal article
Long-term Cognitive Decline in Older Subjects Was Not Attributable to Noncardiac Surgery or Major Illness
Anesthesiology (Philadelphia), Vol.111(5), pp.964-970
11/01/2009
DOI: 10.1097/ALN.0b013e3181bc9719
PMCID: PMC2783989
PMID: 19786858
Abstract
Background: Persistent postoperative cognitive decline is thought to be a public health problem, but its severity may have been overestimated because of limitations in statistical methodology. This study assessed whether long-term cognitive decline occurred after surgery or illness by using an innovative approach and including participants with early Alzheimer disease to overcome some limitations.
Methods: In this retrospective cohort study, three groups were identified from participants tested annually at the Washington University Alzheimer's Disease Research Center in St. Louis, Missouri: those with noncardiac surgery, Illness, or neither. This enabled long-term tracking of cognitive function before and after surgery and illness. The effect of surgery and Illness on longitudinal cognitive course was analyzed using a general linear mixed effects model. For participants without initial dementia, time to dementia onset was analyzed using sequential Cox proportional hazards regression.
Results: Of the 575 participants, 214 were nondemented and 361 had very mild or mild dementia at enrollment. Cognitive trajectories did not differ among the three groups (surgery, illness, control), although demented participants declined more markedly than nondemented participants. Of the initially nondemented. participants, 23% progressed to a clinical dementia rating greater than zero, but this was not more common after surgery or illness.
Conclusions: The study did not detect long-term cognitive decline independently attributable to surgery or illness, nor were these events associated with accelerated progression to dementia. The decision to proceed with surgery in elderly people, including those with early Alzheimer disease, may be made without factoring in the specter of persistent cognitive deterioration.
Details
- Title: Subtitle
- Long-term Cognitive Decline in Older Subjects Was Not Attributable to Noncardiac Surgery or Major Illness
- Creators
- Michael S. Avidan - Washington Univ, Dept Anesthesiol, St Louis, MO 63110 USAAdam C. Searleman - Washington Univ, Med Scientist Training Program, St Louis, MO 63110 USAMartha Storandt - Washington Univ, Dept Psychol, St Louis, MO 63110 USAKara Barnett - Univ Penn, Dept Anesthesiol & Crit Care, Philadelphia, PA 19104 USAAndrea Vannucci - Washington Univ, Dept Anesthesiol, St Louis, MO 63110 USALeif Saager - Cleveland Clin, Dept Outcomes Res, Inst Anesthesiol, Cleveland, OH 44106 USAChengjie Xiong - Washington Univ, Div Biostat, St Louis, MO 63110 USAElizabeth A. Grant - Washington Univ, Div Biostat, St Louis, MO 63110 USADagmar Kaiser - Univ Hosp Bern, Dept Anesthesiol, CH-3010 Bern, SwitzerlandJohn C. Morris - Washington Univ, Memory & Aging Project, St Louis, MO 63110 USAAlex S. Evers - Washington Univ, Dept Anesthesiol, St Louis, MO 63110 USA
- Resource Type
- Journal article
- Publication Details
- Anesthesiology (Philadelphia), Vol.111(5), pp.964-970
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/ALN.0b013e3181bc9719
- PMID
- 19786858
- PMCID
- PMC2783989
- ISSN
- 0003-3022
- eISSN
- 1528-1175
- Number of pages
- 7
- Grant note
- P01AG003991 / NATIONAL INSTITUTE ON AGING; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) P01 AG03991; P50 AG05681 / National Institute on Aging, Bethesda, Maryland; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) University of Missouri Alzheimer's Disease and Related Disorders Program, Columbia, Missouri
- Language
- English
- Date published
- 11/01/2009
- Academic Unit
- Anesthesia
- Record Identifier
- 9984656541602771
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