Abstract
Objective
Participants and Methods
Results
Conclusion
Abbreviations and Acronyms:
AD (Alzheimer disease), DSM-IV (Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)), OR (odds ratio), POCD (prolonged postoperative cognitive decline), REP (Rochester Epidemiology Project)Participants and Methods
Definition of Cases
Selection of Controls
Data Abstraction for Anesthesia History
How old is a rat in human years? Rat Behavior and Biology website. http://www.ratbehavior.org/RatYears. Accessed August 9, 2012.
Statistical Analyses
Results
Characteristic | Dementia due to all causes | Dementia due to Alzheimer disease | ||
---|---|---|---|---|
Controls (N=877) | Cases (N=877) | Controls (N=732) | Cases (N=732) | |
Age at index date (y), mean ± SD | 81.7±8.0 | 81.7±8.0 | 81.3±7.9 | 81.3±7.9 |
Sex | ||||
Male | 241 (27.5) | 241 (27.5) | 203 (27.7) | 203 (27.7) |
Female | 636 (72.5) | 636 (72.5) | 529 (72.3) | 529 (72.3) |
White race | 868 (99.0) | 870 (99.2) | 723 (98.8) | 726 (99.2) |
Education (y) | ||||
<12 | 298 (34.0) | 291 (33.2) | 240 (32.8) | 228 (31.2) |
12 | 225 (25.7) | 214 (24.4) | 187 (25.6) | 184 (25.1) |
>12 | 331 (37.7) | 351 (40.0) | 288 (39.3) | 304 (41.5) |
Unknown | 23 (2.6) | 21 (2.4) | 17 (2.3) | 16 (2.2) |

Type of surgery/procedure | No. (%) of controls (N=877) | No. (%) of cases (N=877) |
---|---|---|
Orthopedic | 214 (24) | 244 (28) |
Obstetrics/gynecology | 208 (24) | 189 (22) |
General (hernia, appendectomy, etc) | 177 (20) | 148 (17) |
Breast | 84 (10) | 87 (10) |
Hepatobiliary | 84 (10) | 86 (10) |
Urologic | 76 (9) | 77 (9) |
Colorectal | 78 (9) | 72 (8) |
Oral and maxillofacial | 61 (7) | 67 (8) |
Vascular | 47 (5) | 51 (6) |
Major cardiac | 40 (5) | 31 (4) |
Endocrine | 37 (4) | 26 (3) |
Ear, nose, and throat | 26 (3) | 30 (3) |
Ophthalmologic | 18 (2) | 20 (2) |
Neurosurgery | 16 (2) | 16 (2) |
Thoracic | 13 (1) | 12 (1) |
Dermatologic | 12 (1) | 9 (1) |
Plastic and reconstructive | 10 (1) | 8 (1) |
Electroconvulsive therapy | 2 (<1) | 4 (<1) |
Other | 12 (1) | 12 (1) |
Exposure | Controls | Cases | Odds ratio | 95% CI | P value |
---|---|---|---|---|---|
Dementia (including Alzheimer dementia) (N=877) | |||||
Any anesthetic | 636 (72.5) | 615 (70.1) | 0.89 | 0.73-1.10 | .27 |
Anesthetic exposure | .51 | ||||
0 | 241 (27.5) | 262 (29.9) | 1.00 | Reference | |
1 | 224 (25.5) | 211 (24.1) | 0.87 | 0.68-1.12 | |
2-3 | 282 (32.2) | 263 (30.0) | 0.86 | 0.67-1.10 | |
≥4 | 130 (14.8) | 141 (16.1) | 1.00 | 0.74-1.35 | |
Cumulative duration of anesthesia (min) b Cumulative duration of anesthesia is the total time an individual was exposed to general anesthesia after age 45 years and before their index date. The odds ratio for total anesthesia duration reflects increased risk per 30 minutes of anesthesia. In all cases, odds ratios were obtained using conditional logistic regression taking into account the matched study design. | 140 (0-305) | 135 (0-307.5) | 1.00 | 0.99-1.01 | .86 |
Cumulative duration of anesthesia (min) | .58 | ||||
0 | 241 (27.5) | 262 (29.9) | 1.00 | Reference | |
1-120 | 163 (18.6) | 159 (18.1) | 0.90 | 0.69-1.19 | |
121-240 | 195 (22.2) | 175 (20.0) | 0.83 | 0.64-1.08 | |
≥241 | 278 (31.7) | 281 (32.0) | 0.93 | 0.73-1.19 | |
Duration of longest single exposure (min) | 105 (0-165) | 100 (0-170) | 0.99 | 0.96-1.02 | .49 |
Duration of longest single exposure (min) | .54 | ||||
0 | 241 (27.5) | 262 (29.9) | 1.00 | Reference | |
1-120 | 268 (30.6) | 249 (28.4) | 0.86 | 0.67-1.10 | |
121-240 | 280 (31.9) | 269 (30.7) | 0.89 | 0.70-1.14 | |
≥241 | 88 (10.0) | 97 (11.1) | 1.02 | 0.72-1.44 | |
Alzheimer disease (excluding other forms of dementia) (N=732) | |||||
Any anesthetic | 535 (73.1) | 516 (70.5) | 0.88 | 0.71-1.11 | .28 |
Anesthetic exposure | .46 | ||||
0 | 197 (26.9) | 216 (29.5) | 1.00 | Reference | |
1 | 191 (26.1) | 176 (24.0) | 0.85 | 0.64-1.11 | |
2-3 | 235 (32.1) | 219 (29.9) | 0.86 | 0.66-1.12 | |
≥4 | 109 (14.9) | 121 (16.5) | 1.02 | 0.74-1.40 | |
Cumulative duration of anesthesia (min) b Cumulative duration of anesthesia is the total time an individual was exposed to general anesthesia after age 45 years and before their index date. The odds ratio for total anesthesia duration reflects increased risk per 30 minutes of anesthesia. In all cases, odds ratios were obtained using conditional logistic regression taking into account the matched study design. | 145 (0-300) | 135 (0-305) | 1.00 | 0.99-1.01 | .78 |
Cumulative duration of anesthesia (min) | .69 | ||||
0 | 197 (26.9) | 216 (29.5) | 1.00 | Reference | |
1-120 | 137 (18.7) | 134 (18.3) | 0.90 | 0.67-1.21 | |
121-240 | 167 (22.8) | 153 (20.9) | 0.84 | 0.63-1.12 | |
241 or more | 231 (31.6) | 229 (31.3) | 0.91 | 0.69-1.19 | |
Duration of longest single exposure (min) b Cumulative duration of anesthesia is the total time an individual was exposed to general anesthesia after age 45 years and before their index date. The odds ratio for total anesthesia duration reflects increased risk per 30 minutes of anesthesia. In all cases, odds ratios were obtained using conditional logistic regression taking into account the matched study design. | 105 (0-165) | 100 (0-167.5) | 0.98 | 0.95-1.01 | .28 |
Duration of longest single exposure (min) | .62 | ||||
0 | 197 (26.9) | 216 (29.5) | 1.00 | Reference | |
1-120 | 226 (30.9) | 216 (29.5) | 0.88 | 0.67-1.14 | |
121-240 | 236 (32.2) | 221 (30.2) | 0.86 | 0.66-1.12 | |
241 or more | 73 (10.0) | 79 (10.8) | 0.99 | 0.68-1.45 |
Anesthetic agent | No. (%) of controls (N=877) | No. (%) of cases (N=877) | Odds ratio | 95% CI | P value |
---|---|---|---|---|---|
Inhalational agents | |||||
Ether | 149 (17) | 152 (17) | 0.94 | 0.71-1.26 | .69 |
Methoxyflurane | 36 (4) | 42 (5) | 1.08 | 0.67-1.74 | .75 |
Cyclopropane | 9 (1) | 7 (1) | 0.73 | 0.27-1.98 | .54 |
Halothane | 255 (29) | 249 (28) | 0.90 | 0.70-1.15 | .40 |
Enflurane | 276 (31) | 292 (33) | 0.97 | 0.77-1.23 | .82 |
Isoflurane | 223 (25) | 191 (22) | 0.78 | 0.60-1.02 | .07 |
Nitrous oxide | 616 (70) | 607 (69) | 0.91 | 0.74-1.12 | .38 |
Intravenous drugs | |||||
Benzodiazepines | 186 (21) | 174 (20) | 0.86 | 0.65-1.13 | .28 |
Sodium thiopental | 612 (70) | 596 (68) | 0.90 | 0.73-1.10 | .30 |
Ketamine | 9 (1) | 7 (1) | 0.72 | 0.27-1.95 | .52 |
Propofol | 6 (1) | 4 (<1) | 0.62 | 0.18-2.22 | .47 |
Intraoperative opioids | 595 (68) | 571 (65) | 0.88 | 0.72-1.09 | .24 |
Discussion
Conclusion
Acknowledgments
Supplemental Online Material
- Supplemental Tables 1-6
References
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Article Info
Publication History
Footnotes
Grant Support: This project was supported by the Department of Anesthesiology, College of Medicine, Mayo Clinic . This study was made possible by the Rochester Epidemiology Project (grant number R01-AG034676 ; Principal Investigators: Walter A. Rocca, MD, MPH, and Barbara P. Yawn, MD, MSc), the Mayo Clinic Center for Translational Sciences Activities , and grant UL1 TR000135 from the National Center for Advancing Translational Sciences .