title: Surgery is associated with ventricular enlargement as well as cognitive and functional decline.
abstract: In preclinical studies, surgery/anesthesia contribute to cognitive decline and enhance neuropathologic changes underlying Alzheimer's disease (AD). Nevertheless, the link between surgery, anesthesia, apolipoprotein E ε4 (APOE ε4), and AD remains unclear.
  
  
  
  We performed a retrospective cohort analysis of two prospective longitudinal aging studies. Mixed-effects statistical models were used to assess the relationship between surgical/anesthetic exposure, the APOE genotype, and rate of change in measures of cognition, function, and brain volumes.
  
  
  
  The surgical group (n = 182) experienced a more rapid rate of deterioration compared with the nonsurgical group (n = 345) in several cognitive, functional, and brain magnetic resonance imaging measures. Furthermore, there was a significant synergistic effect of anesthesia/surgery exposure and presence of the APOE ε4 allele in the decline of multiple cognitive and functional measures.
  
  
  
  These data provide insight into the role of surgical exposure as a risk factor for cognitive and functional decline in older adults.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA. Electronic address: malcore@ohsu.edu.
authors.forename: Katie J
authors.initials: KJ
authors.lastname: Schenning
authors.affiliation: Department of Neurology, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Murchison
authors.affiliation: Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Nora C
authors.initials: NC
authors.lastname: Mattek
authors.affiliation: Department of Neurology, Portland Veterans Affairs Medical Center, Portland, OR, USA; Layton Aging and Alzheimer's Disease Center, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Silbert
authors.affiliation: Department of Neurology, Oregon Health and Science University, Portland, OR, USA; Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, USA; Department of Neurology, Portland Veterans Affairs Medical Center, Portland, OR, USA; Layton Aging and Alzheimer's Disease Center, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kaye
authors.affiliation: Department of Neurology, Oregon Health and Science University, Portland, OR, USA; Department of Neurology, Portland Veterans Affairs Medical Center, Portland, OR, USA; Layton Aging and Alzheimer's Disease Center, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Quinn
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000235:genetics; D053327:Apolipoprotein E4 / Q000235:genetics; D002552:Cerebral Ventricles / Q000002:abnormalities*; D003072:Cognition Disorders / Q000209:etiology* / Q000235:genetics; D018450:Disease Progression; D005260:Female; D005838:Genotype; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
chemical_list: D053327:Apolipoprotein E4
keywords: Alzheimer's disease; Anesthesia; Apolipoprotein E ε4; Cognitive decline; Cohort study; Epidemiology; Postoperative; Surgery; Volumetric MRI