School of Nursing, Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
Department of Medicine, Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
Anaesthesia. 2018 May;73(5):549-555. doi: 10.1111/anae.14216. Epub 2018 Feb 21.
Surgery and anaesthesia might affect cognition in middle-aged people without existing cognitive dysfunction. We measured memory and executive function in 964 participants, mean age 54 years, and again four years later, by when 312 participants had had surgery and 652 participants had not. Surgery between tests was associated with a decline in immediate memory by one point (out of a maximum of 30), p = 0.013: memory became abnormal in 77 out of 670 participants with initially normal memory, 21 out of 114 (18%) of whom had had surgery compared with 56 out of 556 (10%) of those who had not, p = 0.02. The number of operations was associated with a reduction in immediate memory on retesting, beta coefficient (SE) 0.08 (0.03), p = 0.012. Working memory decline was also associated with longer cumulative operations, beta coefficient (SE) -0.01 (0.00), p = 0.028. A reduction in cognitive speed and flexibility was associated with worse ASA physical status, beta coefficient (SE) 0.55 (0.22) and 0.37 (0.17) for ASA 1 and 2 vs. 3, p = 0.035. However, a decline in working memory was associated with better ASA physical status, beta coefficient (SE) -0.48 (0.21) for ASA 1 vs. 3, p = 0.01.
手术和麻醉可能会影响中年人群的认知能力，即使他们没有现有的认知功能障碍。我们对 964 名参与者进行了记忆和执行功能测试，他们的平均年龄为 54 岁，四年后再次进行了测试。在此期间，312 名参与者接受了手术，652 名参与者未接受手术。两次测试之间的手术与即时记忆下降一个点有关（满分 30 分），p = 0.013：在最初记忆正常的 670 名参与者中，有 77 人出现了异常记忆，其中 21 人（18%）接受了手术，而在 556 名未接受手术的参与者中，有 56 人（10%）出现了异常记忆，p = 0.02。手术次数与重新测试时即时记忆的减少有关，β系数（SE）为 0.08（0.03），p = 0.012。工作记忆的下降也与累计手术时间的延长有关，β系数（SE）为-0.01（0.00），p = 0.028。认知速度和灵活性的下降与较差的 ASA 身体状况有关，β系数（SE）为 0.55（0.22）和 0.37（0.17），分别为 ASA 1 和 2 与 3 相比，p = 0.035。然而，工作记忆的下降与较好的 ASA 身体状况有关，β系数（SE）为-0.48（0.21），ASA 1 与 3 相比，p = 0.01。
