Increased risk of dementia in people with previous exposure to general anesthesia: A nationwide population-based case–control study

Abstract Background Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease remains unknown. The potential risk factor of general anesthesia (GA) in the development of dementia is a controversial topic. Ther...

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Published inAlzheimer's & dementia Vol. 10; no. 2; pp. 196 - 204
Main Authors Chen, Chia-Wen, Lin, Che-Chen, Chen, Kuen-Bao, Kuo, Yu-Cheng, Li, Chi-Yuan, Chung, Chi-Jung
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.03.2014
Subjects
Age Factors
Aged
Aged, 80 and over
Alzheimer's disease
Anaesthesia
Anesthesia, General - adverse effects
Atherosclerosis
Case-Control Studies
Case–control study
Community Health Planning
Dementia
Dementia - chemically induced
Dementia - epidemiology
Diabetes mellitus
Female
General anesthesia
Humans
Logistic Models
Male
Middle Aged
National Health Programs
Neurology
Risk
Sedation
Surgery
Taiwan
Taiwan
General anesthesia
Risk
Case–control study
Alzheimer's disease
Dementia
Online AccessGet full text
ISSN1552-5260
1552-5279
1552-5279
DOI10.1016/j.jalz.2013.05.1766

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Abstract Abstract Background Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease remains unknown. The potential risk factor of general anesthesia (GA) in the development of dementia is a controversial topic. Therefore, this study aimed to evaluate the association between previous exposure to different GA types and the incidence of dementia. Methods Using the claims data of 1 million insured residents covered by Taiwan's universal health insurance from 2005 to 2009, 5345 newly diagnosed dementia patients older than 50 years were eligible for the study group. The control group, which consisted of 21,380 individuals without dementia, was matched for age, gender, and index date. GA was categorized into three subtypes: endotracheal tube intubation general anesthesia (ETGA), intravenous injection general anesthesia (IVGA) or intramuscular injection general anesthesia (IMGA), and heavy sedation. The multiple logistic regression model was used for analyses. Results Individuals exposed to surgery under ETGA (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.25–1.44) and those exposed to surgery under IVGA or IMGA (OR, 1.28; 95% CI, 1.14–1.43) were at significantly higher risk of dementia in a dose–response relationship ( P  < .0001), whereas surgery under heavy sedation was not associated with increased risk of dementia (OR, 1.04; 95% CI, 0.68–1.59). The dementia risk for subjects with diabetes mellitus who received surgery under ETGA (OR, 1.59; 95% CI, 1.42–1.78), hypertension (OR, 1.98; 95% CI, 1.78–2.21), atherosclerosis (OR, 1.35; 95% CI, 1.22–1.50), or after having experienced a stroke (OR, 3.52; 95% CI, 3.13–3.97), but no interaction was found between surgery under ETGA and depression for the risk of dementia. Conclusions A history of previous exposure to surgery under GA might be associated with an increased risk of dementia, particularly in subjects who have undergone repeated exposure to GA. In addition, subjects who had received surgery under ETGA with comorbidities such as stroke, hypertension, diabetes mellitus, and atherosclerosis could have a potential relationship with dementia risk.
AbstractList Background: Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease remains unknown. The potential risk factor of general anesthesia (GA) in the development of dementia is a controversial topic. Therefore, this study aimed to evaluate the association between previous exposure to different GA types and the incidence of dementia. Methods: Using the claims data of 1 million insured residents covered by Taiwan's universal health insurance from 2005 to 2009, 5345 newly diagnosed dementia patients older than 50 years were eligible for the study group. The control group, which consisted of 21,380 individuals without dementia, was matched for age, gender, and index date. GA was categorized into three subtypes: endotracheal tube intubation general anesthesia (ETGA), intravenous injection general anesthesia (IVGA) or intramuscular injection general anesthesia (IMGA), and heavy sedation. The multiple logistic regression model was used for analyses. Results: Individuals exposed to surgery under ETGA (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.25-1.44) and those exposed to surgery under IVGA or IMGA (OR, 1.28; 95% CI, 1.14-1.43) were at significantly higher risk of dementia in a dose-response relationship (P < .0001), whereas surgery under heavy sedation was not associated with increased risk of dementia (OR, 1.04; 95% CI, 0.68-1.59). The dementia risk for subjects with diabetes mellitus who received surgery under ETGA (OR, 1.59; 95% CI, 1.42-1.78), hypertension (OR, 1.98; 95% CI, 1.78-2.21), atherosclerosis (OR, 1.35; 95% CI, 1.22-1.50), or after having experienced a stroke (OR, 3.52; 95% CI, 3.13-3.97), but no interaction was found between surgery under ETGA and depression for the risk of dementia. Conclusions: A history of previous exposure to surgery under GA might be associated with an increased risk of dementia, particularly in subjects who have undergone repeated exposure to GA. In addition, subjects who had received surgery under ETGA with comorbidities such as stroke, hypertension, diabetes mellitus, and atherosclerosis could have a potential relationship with dementia risk.
Abstract Background Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease remains unknown. The potential risk factor of general anesthesia (GA) in the development of dementia is a controversial topic. Therefore, this study aimed to evaluate the association between previous exposure to different GA types and the incidence of dementia. Methods Using the claims data of 1 million insured residents covered by Taiwan's universal health insurance from 2005 to 2009, 5345 newly diagnosed dementia patients older than 50 years were eligible for the study group. The control group, which consisted of 21,380 individuals without dementia, was matched for age, gender, and index date. GA was categorized into three subtypes: endotracheal tube intubation general anesthesia (ETGA), intravenous injection general anesthesia (IVGA) or intramuscular injection general anesthesia (IMGA), and heavy sedation. The multiple logistic regression model was used for analyses. Results Individuals exposed to surgery under ETGA (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.25–1.44) and those exposed to surgery under IVGA or IMGA (OR, 1.28; 95% CI, 1.14–1.43) were at significantly higher risk of dementia in a dose–response relationship ( P  < .0001), whereas surgery under heavy sedation was not associated with increased risk of dementia (OR, 1.04; 95% CI, 0.68–1.59). The dementia risk for subjects with diabetes mellitus who received surgery under ETGA (OR, 1.59; 95% CI, 1.42–1.78), hypertension (OR, 1.98; 95% CI, 1.78–2.21), atherosclerosis (OR, 1.35; 95% CI, 1.22–1.50), or after having experienced a stroke (OR, 3.52; 95% CI, 3.13–3.97), but no interaction was found between surgery under ETGA and depression for the risk of dementia. Conclusions A history of previous exposure to surgery under GA might be associated with an increased risk of dementia, particularly in subjects who have undergone repeated exposure to GA. In addition, subjects who had received surgery under ETGA with comorbidities such as stroke, hypertension, diabetes mellitus, and atherosclerosis could have a potential relationship with dementia risk.
Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease remains unknown. The potential risk factor of general anesthesia (GA) in the development of dementia is a controversial topic. Therefore, this study aimed to evaluate the association between previous exposure to different GA types and the incidence of dementia.BACKGROUNDDementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease remains unknown. The potential risk factor of general anesthesia (GA) in the development of dementia is a controversial topic. Therefore, this study aimed to evaluate the association between previous exposure to different GA types and the incidence of dementia.Using the claims data of 1 million insured residents covered by Taiwan's universal health insurance from 2005 to 2009, 5345 newly diagnosed dementia patients older than 50 years were eligible for the study group. The control group, which consisted of 21,380 individuals without dementia, was matched for age, gender, and index date. GA was categorized into three subtypes: endotracheal tube intubation general anesthesia (ETGA), intravenous injection general anesthesia (IVGA) or intramuscular injection general anesthesia (IMGA), and heavy sedation. The multiple logistic regression model was used for analyses.METHODSUsing the claims data of 1 million insured residents covered by Taiwan's universal health insurance from 2005 to 2009, 5345 newly diagnosed dementia patients older than 50 years were eligible for the study group. The control group, which consisted of 21,380 individuals without dementia, was matched for age, gender, and index date. GA was categorized into three subtypes: endotracheal tube intubation general anesthesia (ETGA), intravenous injection general anesthesia (IVGA) or intramuscular injection general anesthesia (IMGA), and heavy sedation. The multiple logistic regression model was used for analyses.Individuals exposed to surgery under ETGA (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.25-1.44) and those exposed to surgery under IVGA or IMGA (OR, 1.28; 95% CI, 1.14-1.43) were at significantly higher risk of dementia in a dose-response relationship (P < .0001), whereas surgery under heavy sedation was not associated with increased risk of dementia (OR, 1.04; 95% CI, 0.68-1.59). The dementia risk for subjects with diabetes mellitus who received surgery under ETGA (OR, 1.59; 95% CI, 1.42-1.78), hypertension (OR, 1.98; 95% CI, 1.78-2.21), atherosclerosis (OR, 1.35; 95% CI, 1.22-1.50), or after having experienced a stroke (OR, 3.52; 95% CI, 3.13-3.97), but no interaction was found between surgery under ETGA and depression for the risk of dementia.RESULTSIndividuals exposed to surgery under ETGA (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.25-1.44) and those exposed to surgery under IVGA or IMGA (OR, 1.28; 95% CI, 1.14-1.43) were at significantly higher risk of dementia in a dose-response relationship (P < .0001), whereas surgery under heavy sedation was not associated with increased risk of dementia (OR, 1.04; 95% CI, 0.68-1.59). The dementia risk for subjects with diabetes mellitus who received surgery under ETGA (OR, 1.59; 95% CI, 1.42-1.78), hypertension (OR, 1.98; 95% CI, 1.78-2.21), atherosclerosis (OR, 1.35; 95% CI, 1.22-1.50), or after having experienced a stroke (OR, 3.52; 95% CI, 3.13-3.97), but no interaction was found between surgery under ETGA and depression for the risk of dementia.A history of previous exposure to surgery under GA might be associated with an increased risk of dementia, particularly in subjects who have undergone repeated exposure to GA. In addition, subjects who had received surgery under ETGA with comorbidities such as stroke, hypertension, diabetes mellitus, and atherosclerosis could have a potential relationship with dementia risk.CONCLUSIONSA history of previous exposure to surgery under GA might be associated with an increased risk of dementia, particularly in subjects who have undergone repeated exposure to GA. In addition, subjects who had received surgery under ETGA with comorbidities such as stroke, hypertension, diabetes mellitus, and atherosclerosis could have a potential relationship with dementia risk.
Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease remains unknown. The potential risk factor of general anesthesia (GA) in the development of dementia is a controversial topic. Therefore, this study aimed to evaluate the association between previous exposure to different GA types and the incidence of dementia. Using the claims data of 1 million insured residents covered by Taiwan's universal health insurance from 2005 to 2009, 5345 newly diagnosed dementia patients older than 50 years were eligible for the study group. The control group, which consisted of 21,380 individuals without dementia, was matched for age, gender, and index date. GA was categorized into three subtypes: endotracheal tube intubation general anesthesia (ETGA), intravenous injection general anesthesia (IVGA) or intramuscular injection general anesthesia (IMGA), and heavy sedation. The multiple logistic regression model was used for analyses. Individuals exposed to surgery under ETGA (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.25-1.44) and those exposed to surgery under IVGA or IMGA (OR, 1.28; 95% CI, 1.14-1.43) were at significantly higher risk of dementia in a dose-response relationship (P < .0001), whereas surgery under heavy sedation was not associated with increased risk of dementia (OR, 1.04; 95% CI, 0.68-1.59). The dementia risk for subjects with diabetes mellitus who received surgery under ETGA (OR, 1.59; 95% CI, 1.42-1.78), hypertension (OR, 1.98; 95% CI, 1.78-2.21), atherosclerosis (OR, 1.35; 95% CI, 1.22-1.50), or after having experienced a stroke (OR, 3.52; 95% CI, 3.13-3.97), but no interaction was found between surgery under ETGA and depression for the risk of dementia. A history of previous exposure to surgery under GA might be associated with an increased risk of dementia, particularly in subjects who have undergone repeated exposure to GA. In addition, subjects who had received surgery under ETGA with comorbidities such as stroke, hypertension, diabetes mellitus, and atherosclerosis could have a potential relationship with dementia risk.
Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease remains unknown. The potential risk factor of general anesthesia (GA) in the development of dementia is a controversial topic. Therefore, this study aimed to evaluate the association between previous exposure to different GA types and the incidence of dementia. Using the claims data of 1 million insured residents covered by Taiwan's universal health insurance from 2005 to 2009, 5345 newly diagnosed dementia patients older than 50 years were eligible for the study group. The control group, which consisted of 21,380 individuals without dementia, was matched for age, gender, and index date. GA was categorized into three subtypes: endotracheal tube intubation general anesthesia (ETGA), intravenous injection general anesthesia (IVGA) or intramuscular injection general anesthesia (IMGA), and heavy sedation. The multiple logistic regression model was used for analyses. Individuals exposed to surgery under ETGA (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.25–1.44) and those exposed to surgery under IVGA or IMGA (OR, 1.28; 95% CI, 1.14–1.43) were at significantly higher risk of dementia in a dose–response relationship (P < .0001), whereas surgery under heavy sedation was not associated with increased risk of dementia (OR, 1.04; 95% CI, 0.68–1.59). The dementia risk for subjects with diabetes mellitus who received surgery under ETGA (OR, 1.59; 95% CI, 1.42–1.78), hypertension (OR, 1.98; 95% CI, 1.78–2.21), atherosclerosis (OR, 1.35; 95% CI, 1.22–1.50), or after having experienced a stroke (OR, 3.52; 95% CI, 3.13–3.97), but no interaction was found between surgery under ETGA and depression for the risk of dementia. A history of previous exposure to surgery under GA might be associated with an increased risk of dementia, particularly in subjects who have undergone repeated exposure to GA. In addition, subjects who had received surgery under ETGA with comorbidities such as stroke, hypertension, diabetes mellitus, and atherosclerosis could have a potential relationship with dementia risk.
Background: Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease remains unknown. The potential risk factor of general anesthesia (GA) in the development of dementia is a controversial topic. Therefore, this study aimed to evaluate the association between previous exposure to different GA types and the incidence of dementia. Methods: Using the claims data of 1 million insured residents covered by Taiwan's universal health insurance from 2005 to 2009, 5345 newly diagnosed dementia patients older than 50 years were eligible for the study group. The control group, which consisted of 21,380 individuals without dementia, was matched for age, gender, and index date. GA was categorized into three subtypes: endotracheal tube intubation general anesthesia (ETGA), intravenous injection general anesthesia (IVGA) or intramuscular injection general anesthesia (IMGA), and heavy sedation. The multiple logistic regression model was used for analyses. Results: Individuals exposed to surgery under ETGA (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.25-1.44) and those exposed to surgery under IVGA or IMGA (OR, 1.28; 95% CI, 1.14-1.43) were at significantly higher risk of dementia in a dose-response relationship (P < .0001), whereas surgery under heavy sedation was not associated with increased risk of dementia (OR, 1.04; 95% CI, 0.68-1.59). The dementia risk for subjects with diabetes mellitus who received surgery under ETGA (OR, 1.59; 95% CI, 1.42-1.78), hypertension (OR, 1.98; 95% CI, 1.78-2.21), atherosclerosis (OR, 1.35; 95% CI, 1.22-1.50), or after having experienced a stroke (OR, 3.52; 95% CI, 3.13-3.97), but no interaction was found between surgery under ETGA and depression for the risk of dementia. Conclusions: A history of previous exposure to surgery under GA might be associated with an increased risk of dementia, particularly in subjects who have undergone repeated exposure to GA. In addition, subjects who had received surgery under ETGA with comorbidities such as stroke, hypertension, diabetes mellitus, and atherosclerosis could have a potential relationship with dementia risk. [Copyright Elsevier B.V.]
Background Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease remains unknown. The potential risk factor of general anesthesia (GA) in the development of dementia is a controversial topic. Therefore, this study aimed to evaluate the association between previous exposure to different GA types and the incidence of dementia. Methods Using the claims data of 1 million insured residents covered by Taiwan's universal health insurance from 2005 to 2009, 5345 newly diagnosed dementia patients older than 50 years were eligible for the study group. The control group, which consisted of 21,380 individuals without dementia, was matched for age, gender, and index date. GA was categorized into three subtypes: endotracheal tube intubation general anesthesia (ETGA), intravenous injection general anesthesia (IVGA) or intramuscular injection general anesthesia (IMGA), and heavy sedation. The multiple logistic regression model was used for analyses. Results Individuals exposed to surgery under ETGA (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.25–1.44) and those exposed to surgery under IVGA or IMGA (OR, 1.28; 95% CI, 1.14–1.43) were at significantly higher risk of dementia in a dose–response relationship (P < .0001), whereas surgery under heavy sedation was not associated with increased risk of dementia (OR, 1.04; 95% CI, 0.68–1.59). The dementia risk for subjects with diabetes mellitus who received surgery under ETGA (OR, 1.59; 95% CI, 1.42–1.78), hypertension (OR, 1.98; 95% CI, 1.78–2.21), atherosclerosis (OR, 1.35; 95% CI, 1.22–1.50), or after having experienced a stroke (OR, 3.52; 95% CI, 3.13–3.97), but no interaction was found between surgery under ETGA and depression for the risk of dementia. Conclusions A history of previous exposure to surgery under GA might be associated with an increased risk of dementia, particularly in subjects who have undergone repeated exposure to GA. In addition, subjects who had received surgery under ETGA with comorbidities such as stroke, hypertension, diabetes mellitus, and atherosclerosis could have a potential relationship with dementia risk.
Author Chung, Chi-Jung
Li, Chi-Yuan
Chen, Kuen-Bao
Chen, Chia-Wen
Kuo, Yu-Cheng
Lin, Che-Chen
Author_xml – sequence: 1
  fullname: Chen, Chia-Wen
– sequence: 2
  fullname: Lin, Che-Chen
– sequence: 3
  fullname: Chen, Kuen-Bao
– sequence: 4
  fullname: Kuo, Yu-Cheng
– sequence: 5
  fullname: Li, Chi-Yuan
– sequence: 6
  fullname: Chung, Chi-Jung
BackLink https://www.ncbi.nlm.nih.gov/pubmed/23896612$$D View this record in MEDLINE/PubMed
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2014 The Alzheimer's Association
Copyright © 2014 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.
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Keywords General anesthesia
Risk
Case–control study
Alzheimer's disease
Dementia
Language English
License Copyright © 2014 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.
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SSID ssj0040815
Score 2.3897889
Snippet Abstract Background Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of...
Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease remains...
Background Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease...
Background: Dementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the...
SourceID proquest
pubmed
crossref
wiley
elsevier
SourceType Aggregation Database
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Publisher
StartPage 196
SubjectTerms Age Factors
Aged
Aged, 80 and over
Alzheimer's disease
Anaesthesia
Anesthesia, General - adverse effects
Atherosclerosis
Case-Control Studies
Case–control study
Community Health Planning
Dementia
Dementia - chemically induced
Dementia - epidemiology
Diabetes mellitus
Female
General anesthesia
Humans
Logistic Models
Male
Middle Aged
National Health Programs
Neurology
Risk
Sedation
Surgery
Taiwan
Title Increased risk of dementia in people with previous exposure to general anesthesia: A nationwide population-based case–control study
URI https://www.clinicalkey.es/playcontent/1-s2.0-S1552526013024266
https://dx.doi.org/10.1016/j.jalz.2013.05.1766
https://onlinelibrary.wiley.com/doi/abs/10.1016%2Fj.jalz.2013.05.1766
https://www.ncbi.nlm.nih.gov/pubmed/23896612
https://www.proquest.com/docview/1513048344
https://www.proquest.com/docview/1534828147
https://www.proquest.com/docview/1558990428
Volume 10
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