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Association between major surgical admissions and the cognitive trajectory: 19 year follow-up of Whitehall II cohort study

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4466 (Published 07 August 2019) Cite this as: BMJ 2019;366:l4466

Linked editorial

The determinants of cognitive decline and dementia

Some Surgical Admissions May Protect Against Cognitive Decline

Krause and colleagues produce a methodological robust analysis of the effect of surgical admission on long-term cognitive function (1). It is however premature to conclude, as the authors do, that surgical admissions are associated with cognitive decline. Indeed it is likely that surgical admission has a heterogeneous effect on cognition dependent on a number of factors.

Evidence suggests that some surgeries may even result in long-term neuro-protection. Killinger et al writing in Science's sister journal, in a study involving 1.6 million patients, found that appendicectomy reduced the risk of Parkinson's disease by almost 20%. (2) Loss of cognitive function is a component of Parkinson's disease. (3) Over 42,000 appendicectomies are performed annually in the UK (4). In 80% of cases the length of stay for this procedure is greater than 2 days (4). Hence these events would be captured and included in the present study, as a major surgical admission. The evidence present does not support the notion that surgical admissions have a monolithic unipolar association with long-term cognitive paracme.

(1) Krause BM, Sabia S, Manning HJ, Singh-Manoux A, Sanders RD.Association between major surgical admissions and the cognitive trajectory: 19 year follow-up of Whitehall II cohort study. BMJ. 2019 Aug 7;366:l4466

(2) Killinger BA, Madaj Z, Sikora JW, Rey N, Haas AJ, Vepa Y, Lindqvist D, Chen H, Thomas PM, Brundin P, Brundin L, Labrie V. The vermiform appendix impacts the risk of developing Parkinson's disease. Sci Transl Med. 2018 Oct 31;10(465).

(3) Marinus J, Zhu K, Marras C, Aarsland D, van Hilten JJ. Risk factors for non-motor symptoms in Parkinson's disease. Lancet Neurol. 2018 Jun;17(6):559-568. doi: 10.1016/S1474-4422(18)30127-3

(4) https://gettingitrightfirsttime.co.uk/wp-content/uploads/2017/08/GIRFT-G...

Competing interests: No competing interests

14 August 2019
Chika E Uzoigwe
doctor
Daman Sharma, Taj Shah, Farzad Shabani,
Harcourt House