- Email: [email protected]
SURGERY AND COGNITIVE DECLINE IN THE WISCONSIN REGISTRY FOR ALZHEIMER'S PREVENTION (WRAP) DATABASE
Podium Presentations: Thursday, July 28, 2016
Among participants exposed to surgery/GA, the APOE4+ group experienced a more dramatic rate of increase in ventricular volume over time compared to the exposed APOE4- group (p¼0.017). The rates of change in the other measured brain volumes did not differ based on APOE4 status. Finally, while men exposed to surgery/ GA experienced a more rapid rate of decline than their unexposed counterparts in Mini-Mental State Examination (MMSE) (p¼0.009), Instrumental Activities of Daily Living (IADL, p¼0.024), and Clinical Dementia Rating-Sum of Boxes (CDRSB, p¼0.027), women exposed to surgery/GA experienced a significantly more rapid rate of deterioration in the following outcomes: MMSE (p<0.001), CDR (p¼0.003), CDR-SB (p<0.001), Activities of Daily Living (ADL, p<0.001), Delayed Logical Memory (p¼0.011), and ventricular volume (p¼0.005). Conclusions: Older adults with an exposure to surgery/GA had a more rapid rate of cognitive and functional decline as well as ventricular enlargement when compared to those who did not undergo surgery/GA. These findings were more prounounced in the APOE4+ group than the APOE4- group. Finally, exposure to surgery/GA in older women was associated with more rapid rates of decline in measures of cognition, function, and brain volumes than older men. F5-01-02
anesthesia were obtained. Cardiac and intracranial procedures were excluded. Neuropsychological test scores were grouped into a memory domain (Immediate Memory (IM), Verbal Learning and Memory (VLM)), and an executive function domain (Speed and Flexibility (SF) and Working Memory (WM)) by factor analysis, and standardized to z-scores. Memory and executive function performances were classified to be within robust limits (WRL) or below robust limits (BRL) if a factor score within a domain was 1.5 standard deviations or more below internal norms adjusted for age, gender, and literacy. (Koscik RL et al. Dement Geriatr Cogn Disord. 2014;38(1-2):16-30.). Results: 312 participants had 506 qualifying surgeries. 652 participants served as no-surgery controls. 17.5% of participants with no memory deficits (WRL) at visit 1 having surgery between visit 1 and 2 had memory BRL at visit 2 compared to 10.1% in the no-surgery group (p¼0.022). The number of surgeries from 5 years before enrollment to visit 2 was a significant predictor of a decline in IM scores in those having surgery between visit 1 and 2 (p¼0.012). ApoE4 positive participants who had surgery between visits 1 and 2 had a greater decline in executive function at visit 2 than ApoE4 negative participants who had surgery between visits 1 and 2 (p¼0.031). Conclusions: Participants having surgery were at increased risk for cognitive decrements than participants who did not have surgery.
DEMENTIA AFTER SURGERY IN SWEDEN
Lars I. Eriksson, Nancy L. Pedersen, Karolinska Institutet, Stockholm, Sweden. Contact e-mail: [email protected] Background: There is currently a controversy regarding the longterm
impact of major surgery on subsequent cognitive performance and risk for dementia. Methods: A nested case-control study was performed within the population-based Swedish Twin Registry (STR) based on two samples of individuals: a clinical sample with individuals with a diagnosis of dementia based on clinical assessment within STR studies, and a register sample with dementia diagnosis retrieved from the Swedish National Patient Registry (NPR), Cause of death registry and Prescribed drug registry. All dementia cases were matched with 5 non-demented individuals and combined with information on hospitalizations and surgical procedures recorded in the NPR between 1977-2012. Results: Hospitalizations for surgical or non-surgical conditions are associated with increased risk for dementia, however, hospitalizations for non-surgical reasons or critical illness are associated with a markedly higher risk for dementia than for surgical procedures. The risks of dementia increased with increasing number of non-surgical hospitalizations, and were significant 10 to 20 years past hospitalization. There was no increased risk with surgery after 80 years of age, which may reflect selection bias. Conclusions: Patients and providers should be more concerned about the consequences of repeated hospitalizations or critical illness than about surgery as a major risk factor for dementia. F5-01-03
P367
SURGERY AND COGNITIVE DECLINE IN THE WISCONSIN REGISTRY FOR ALZHEIMER’S PREVENTION (WRAP) DATABASE
Kirk J. Hogan, University of Wisconsin, Madison, Madison, WI, USA. Contact e-mail: [email protected] Background: The effects of surgery and anesthesia on incident de-
mentia are unknown. Accordingly, in a sample enriched for healthy adult children of parents with Alzheimer’s disease, psychometric test performance at enrollment (visit 1) and at 4 years later (visit 2) was compared in participants with and without surgery in the 9 year interval from 5 years before visit 1 to visit 2. Methods: Records of surgical procedures requiring general, spinal or epidural
F5-01-04
ASSOCIATION OF MILD COGNITIVE IMPAIRMENT WITH EXPOSURE TO GENERAL ANESTHESIA FOR SURGICAL AND NONSURGICAL PROCEDURES IN OLMSTED COUNTY, MINNESOTA
David S. Knopman, Yvette Martin, Juraj Sprung, Rosebud O. Roberts, David Warner, Ronald C. Petersen, Mayo Clinic, Rochester, MN, USA. Contact e-mail: [email protected] Background: Cognitive impairment is often attributed to exposure to general anesthesia and surgery even when the temporal relationship is remote. We had the opportunity to examine the relationship of prior anesthesia and surgery to earliest manifestations of cognitive impairment using a prospective population-based cohort combined with medical record documentation of prior surgical events. Methods: The Mayo Clinic Study of Aging (MCSA) is a population-based study of individuals in Olmsted County MN who were age 70-89 years at enrollment beginning in 2004. They have been followed for a median of 4.8 years and standard criteria were used to diagnose incident MCI in the subset of individuals who were cognitively normal at baseline. Exposure to surgery and anesthesia after age 40 years of age was documented by medical record review using the facilities of the Rochester Epidemiology Project’s records linkage system for Olmsted County. Results: Thirty one percent (n¼536) of 1731 initially cognitively normal individuals developed incident MCI over the period of observation. Exposure to anesthesia was not associated with incident MCI when analyzed as a dichotomous variable (HR¼1.07, 95% CI 0.83-1.37) or when multiple exposures were considered. Exposure to anesthesia after age 60 years of age was weakly associated with incident MCI (HR¼1.25, 95%CI 1.02-1.55, p¼0.04). Conclusions: Overall there was no significant associations between exposure to general anesthesia beginning at age 40 years. Our results do not exclude the possibility of an association with incident MCI of exposure to general anesthesia after age 60, but the latter is confounded by the presence of underlying comorbidities that could be directly linked to dementia risk. Supported by: R01AG034676, P50-AG16574, U01-AG006786.
Among participants exposed to surgery/GA, the APOE4+ group experienced a more dramatic rate of increase in ventricular volume over time compared to the exposed APOE4- group (p¼0.017). The rates of change in the other measured brain volumes did not differ based on APOE4 status. Finally, while men exposed to surgery/ GA experienced a more rapid rate of decline than their unexposed counterparts in Mini-Mental State Examination (MMSE) (p¼0.009), Instrumental Activities of Daily Living (IADL, p¼0.024), and Clinical Dementia Rating-Sum of Boxes (CDRSB, p¼0.027), women exposed to surgery/GA experienced a significantly more rapid rate of deterioration in the following outcomes: MMSE (p<0.001), CDR (p¼0.003), CDR-SB (p<0.001), Activities of Daily Living (ADL, p<0.001), Delayed Logical Memory (p¼0.011), and ventricular volume (p¼0.005). Conclusions: Older adults with an exposure to surgery/GA had a more rapid rate of cognitive and functional decline as well as ventricular enlargement when compared to those who did not undergo surgery/GA. These findings were more prounounced in the APOE4+ group than the APOE4- group. Finally, exposure to surgery/GA in older women was associated with more rapid rates of decline in measures of cognition, function, and brain volumes than older men. F5-01-02
anesthesia were obtained. Cardiac and intracranial procedures were excluded. Neuropsychological test scores were grouped into a memory domain (Immediate Memory (IM), Verbal Learning and Memory (VLM)), and an executive function domain (Speed and Flexibility (SF) and Working Memory (WM)) by factor analysis, and standardized to z-scores. Memory and executive function performances were classified to be within robust limits (WRL) or below robust limits (BRL) if a factor score within a domain was 1.5 standard deviations or more below internal norms adjusted for age, gender, and literacy. (Koscik RL et al. Dement Geriatr Cogn Disord. 2014;38(1-2):16-30.). Results: 312 participants had 506 qualifying surgeries. 652 participants served as no-surgery controls. 17.5% of participants with no memory deficits (WRL) at visit 1 having surgery between visit 1 and 2 had memory BRL at visit 2 compared to 10.1% in the no-surgery group (p¼0.022). The number of surgeries from 5 years before enrollment to visit 2 was a significant predictor of a decline in IM scores in those having surgery between visit 1 and 2 (p¼0.012). ApoE4 positive participants who had surgery between visits 1 and 2 had a greater decline in executive function at visit 2 than ApoE4 negative participants who had surgery between visits 1 and 2 (p¼0.031). Conclusions: Participants having surgery were at increased risk for cognitive decrements than participants who did not have surgery.
DEMENTIA AFTER SURGERY IN SWEDEN
Lars I. Eriksson, Nancy L. Pedersen, Karolinska Institutet, Stockholm, Sweden. Contact e-mail: [email protected] Background: There is currently a controversy regarding the longterm
impact of major surgery on subsequent cognitive performance and risk for dementia. Methods: A nested case-control study was performed within the population-based Swedish Twin Registry (STR) based on two samples of individuals: a clinical sample with individuals with a diagnosis of dementia based on clinical assessment within STR studies, and a register sample with dementia diagnosis retrieved from the Swedish National Patient Registry (NPR), Cause of death registry and Prescribed drug registry. All dementia cases were matched with 5 non-demented individuals and combined with information on hospitalizations and surgical procedures recorded in the NPR between 1977-2012. Results: Hospitalizations for surgical or non-surgical conditions are associated with increased risk for dementia, however, hospitalizations for non-surgical reasons or critical illness are associated with a markedly higher risk for dementia than for surgical procedures. The risks of dementia increased with increasing number of non-surgical hospitalizations, and were significant 10 to 20 years past hospitalization. There was no increased risk with surgery after 80 years of age, which may reflect selection bias. Conclusions: Patients and providers should be more concerned about the consequences of repeated hospitalizations or critical illness than about surgery as a major risk factor for dementia. F5-01-03
P367
SURGERY AND COGNITIVE DECLINE IN THE WISCONSIN REGISTRY FOR ALZHEIMER’S PREVENTION (WRAP) DATABASE
Kirk J. Hogan, University of Wisconsin, Madison, Madison, WI, USA. Contact e-mail: [email protected] Background: The effects of surgery and anesthesia on incident de-
mentia are unknown. Accordingly, in a sample enriched for healthy adult children of parents with Alzheimer’s disease, psychometric test performance at enrollment (visit 1) and at 4 years later (visit 2) was compared in participants with and without surgery in the 9 year interval from 5 years before visit 1 to visit 2. Methods: Records of surgical procedures requiring general, spinal or epidural
F5-01-04
ASSOCIATION OF MILD COGNITIVE IMPAIRMENT WITH EXPOSURE TO GENERAL ANESTHESIA FOR SURGICAL AND NONSURGICAL PROCEDURES IN OLMSTED COUNTY, MINNESOTA
David S. Knopman, Yvette Martin, Juraj Sprung, Rosebud O. Roberts, David Warner, Ronald C. Petersen, Mayo Clinic, Rochester, MN, USA. Contact e-mail: [email protected] Background: Cognitive impairment is often attributed to exposure to general anesthesia and surgery even when the temporal relationship is remote. We had the opportunity to examine the relationship of prior anesthesia and surgery to earliest manifestations of cognitive impairment using a prospective population-based cohort combined with medical record documentation of prior surgical events. Methods: The Mayo Clinic Study of Aging (MCSA) is a population-based study of individuals in Olmsted County MN who were age 70-89 years at enrollment beginning in 2004. They have been followed for a median of 4.8 years and standard criteria were used to diagnose incident MCI in the subset of individuals who were cognitively normal at baseline. Exposure to surgery and anesthesia after age 40 years of age was documented by medical record review using the facilities of the Rochester Epidemiology Project’s records linkage system for Olmsted County. Results: Thirty one percent (n¼536) of 1731 initially cognitively normal individuals developed incident MCI over the period of observation. Exposure to anesthesia was not associated with incident MCI when analyzed as a dichotomous variable (HR¼1.07, 95% CI 0.83-1.37) or when multiple exposures were considered. Exposure to anesthesia after age 60 years of age was weakly associated with incident MCI (HR¼1.25, 95%CI 1.02-1.55, p¼0.04). Conclusions: Overall there was no significant associations between exposure to general anesthesia beginning at age 40 years. Our results do not exclude the possibility of an association with incident MCI of exposure to general anesthesia after age 60, but the latter is confounded by the presence of underlying comorbidities that could be directly linked to dementia risk. Supported by: R01AG034676, P50-AG16574, U01-AG006786.