The Association Between Surgery and Mild Cognitive Impairment: Insight from a Case-Control Study

Article type: Research Article

Authors: Yu, Jian^{a; b; 1} | Tang, Wenyu^{a; b; 1} | Sulaiman, Zubaidan^{b; c} | Ma, Xin^{a; b} | Wang, Jiayi^{a; b} | Shi, Zhongyong^{b; c} | Liu, Qidong^b | Xie, Zhongcong^{d; *} | Shen, Yuan^{b; c; *} | for the Alzheimer’s Disease Neuroimaging Initiative²

Affiliations: [a] Department of Psychiatry, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China | [b] Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, China | [c] Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China | [d] Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA

Correspondence: [*] Correspondence to: Yuan Shen, MD, PhD, Shanghai Mental Health Center, 600 Wan Ping Nan Road, Shanghai 200030, P. R. China. Tel.: +86 21 34773168; Fax: +86 21 34773168; E-mail: kmshy@tongji.edu.cn and Zhongcong Xie, MD, PhD, Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Room 4310, Charlestown, MA 02129, USA. Tel.: +1 617 724 9308; Fax: +1 617 643 9277; E-mail: zxie@mgh.harvard.edu.

Note: [1] These authors contributed equally to this work.

Note: [2] Data used in the preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (http://adni.loni.usc.edu). As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or writing of this report. A complete listing of ADNI investigators can be found at http://adni.loni.usc.edu/wp-content/uploads/how_to_apply/ADNI_Acknowledgement_List.pdf.

Abstract: Background:Surgery may be associated with postoperative cognitive impairment in elder participants, yet the extent of its association with mild cognitive impairment (MCI) remains undetermined. Objective:To determine the relationship between surgery and MCI. Methods:The data of participants from the Alzheimer’s Disease Neuroimaging Initiative were analyzed, including individuals with MCI or normal cognition. We focused on surgeries conducted after the age of 45, categorized by the number of surgeries, surgical risk, and the age at which surgeries occurred. Multivariable logistic regression was employed to determine the association between surgery and the development of MCI. Results:The study is comprised of 387 individuals with MCI and 578 cognitively normal individuals. The overall surgery exposure (adjusted OR = 1.14, [95% CI 0.83, 1.56], p = 0.43) and the number of surgeries (adjusted OR = 0.92  [0.62, 1.36], p = 0.67 for single exposure, adjusted OR = 1.12 [0.71, 1.78], p = 0.63 for two exposures, adjusted OR = 1.38 [0.95, 2.01], p = 0.09 for three or more exposures compared to no exposure as the reference) were not associated with the development of MCI. However, high-risk surgeries (adjusted OR = 1.79 [1.00, 3.21], p = 0.049) or surgeries occurring after the age of 75 (adjusted OR = 2.01 [1.03, 3.90], p = 0.041) were associated with a greater risk of developing MCI. Conclusions:High risk surgeries occurring at an older age contribute to the development of MCI, indicating a complex of mechanistic insights for the development of postoperative cognitive impairment.

Keywords: Aging, Alzheimer’s disease, elderly, geriatric, mild cognitive impairment, surgery

DOI: 10.3233/JAD-240467

Journal: Journal of Alzheimer's Disease, vol. 100, no. 4, pp. 1379-1388, 2024