. Long-term cognitive decline in older subjects was not attributable to noncardiac surgery or major illness. Anesthesiology. 2009 Nov;111(5):964-70. PubMed.

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  1. This is an important study. It sets new standards for the approach to peri-operative influences on cognition in the elderly by using established AD cohorts within the ADRC groups, and by examining and comparing both pre-surgery and post-surgery cognitive trajectories. Although this initial study could not detect a difference in these trajectories among control, illness, and surgery
    groups, the authors quite properly identified weaknesses that
    prevent it from being definitive at this point.

    These weaknesses include:

    1. Modest size: some groups had as few as 27 patients.

    2. Heterogeneity with respect to surgical procedures.

    3. A lack of detail with respect to surgery and anesthesia.

    4. Capture of procedures that occurred primarily at Wash U.
    hospitals; i.e., controls may have had surgery/illness elsewhere during
    the study period.

    5. No information on surgery or illness prior to ADRC entry.

    6. Elderly nature of all patients: vulnerable window not yet
    defined.

    7. Controls are not "wild-type" in that many are likely to be
    family members and therefore at higher risk of having AD neuropathology.

    To address these limitations, the authors have begun to recruit a
    much larger cohort involving multiple ADRCs, including those at UPenn, Harvard, WashU, Columbia, and others. This effort will take much longer but should be more definitive. It still has the problem of a narrow age window. Like head trauma is known to do, it could be that anesthesia and surgery change the trajectory of the neuropathology much earlier, long before any cognitive changes are
    evident, a possibility that this study design cannot capture. To at least capture more acute changes in neuropathology, I am advocating for well-designed peri-operative biomarker and/or imaging studies. We and other groups interested in this issue will be discussing both the basic and clinical science at a small meeting in Toronto in June 2010.

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  1. Anesthesia and Cognitive Decline: No Link in Longitudinal Study