Association between surgical admissions, cognition, and neurodegeneration in older people: a population-based study from the UK Biobank.

Autor:	Taylor J; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. Electronic address: jennifer.taylor1@sydney.edu.au., Robledo KP; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia., Medel V; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile., Heller G; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia., Payne T; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia., Wehrman J; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia., Casey C; Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA., Yang PF; Surgical Outcomes Research Centre (SOuRCe), Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; South West Sydney Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia., Krause BM; Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA., Lennertz R; Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA., Naismith S; Healthy Brain Ageing Program, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia., Teixeira-Pinto A; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia., Sanders RD; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Jazyk:	angličtina
Zdroj:	The lancet. Healthy longevity [Lancet Healthy Longev] 2024 Sep; Vol. 5 (9), pp. 100623. Date of Electronic Publication: 2024 Sep 05.
DOI:	10.1016/j.lanhl.2024.07.006
Abstrakt:	Background: Previous studies have shown that major surgical and medical hospital admissions are associated with cognitive decline in older people (aged 40-69 years at recruitment), which is concerning for patients and caregivers. We aimed to validate these findings in a large cohort and investigate associations with neurodegeneration using MRI. Methods: For this population-based study, we analysed data from the UK Biobank collected from March 13, 2006, to July 16, 2023, linked to the National Health Service Hospital Episode Statistics database, excluding participants with dementia diagnoses. We constructed fully adjusted models that included age, time, sex, Lancet Commission dementia risk factors, stroke, and hospital admissions with a participant random effect. Primary outcomes were hippocampal volume and white matter hyperintensities, both of which are established markers of neurodegeneration, and exploratory analyses investigated the cortical thickness of Desikan-Killiany-Tourville atlas regions. The main cognitive outcomes were reaction time, fluid intelligence, and prospective and numeric memory. Surgeries were calculated cumulatively starting from 8 years before the baseline evaluation. Findings: Of 502 412 participants in the UK Biobank study, 492 802 participants were eligible for inclusion in this study, of whom 46 706 underwent MRI. Small adverse associations with cognition were found per surgery: reaction time increased by 0·273 ms, fluid intelligence score decreased by 0·057 correct responses, prospective memory (scored as correct at first attempt) decreased (odds ratio 0·96 [95% CI 0·95 to 0·97]), and numeric memory maximum correct matches decreased by 0·025 in fully adjusted models. Surgeries were associated with smaller hippocampal volume (β=-5·76 mm³ [-7·89 to -3·64]) and greater white matter hyperintensities volume (β=100·02 mm³ [66·17 to 133·87]) in fully adjusted models. Surgeries were also associated with neurodegeneration of the insula and superior temporal cortex. Interpretation: This population-based study corroborates that surgeries are generally safe but cumulatively are associated with cognitive decline and neurodegeneration. Perioperative brain health should be prioritised for older and vulnerable patients, particularly those who have multiple surgical procedures. Funding: The Australian and New Zealand College of Anaesthetists (ANZCA) Foundation and the University of Sydney. Competing Interests: Declaration of interests RDS and RL received support from US National Institutes of Health (NIH) grant R01 AG063849-01. CC received support from NIH R01 HD098202-02 and NIH R01 NS117901-01. SN declares consulting fees from Eisai, Roche, and Nutrica Pharmaceuticals. All other authors declare no competing interests. (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu