{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T02:31:41Z","timestamp":1788402701290,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["2P01AG031720"],"award-info":[{"award-number":["2P01AG031720"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R33AG071744"],"award-info":[{"award-number":["R33AG071744"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG079864"],"award-info":[{"award-number":["R01AG079864"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG051658"],"award-info":[{"award-number":["R01AG051658"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K24 AG0305075"],"award-info":[{"award-number":["K24 AG0305075"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>(1) To describe cognitive trajectory patterns over 6\u2009years after major surgery in older adults, and (2) To identify patient characteristics associated with severe cognitive decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Group\u2010based semiparametric trajectory modeling was performed on longitudinal cognitive data from the SAGES study, which enrolled patients aged \u2265\u200970\u2009years undergoing major elective noncardiac surgery. Participants received comprehensive neuropsychological testing prior to surgery and postoperatively every 6\u201312\u2009months up to 72\u2009months. The primary outcome was change in general cognitive performance score, a composite of neuropsychological tests, at each of 11 follow\u2010up timepoints relative to baseline. Generalized linear models were used to assess the associations of pre\u2010surgical patient characteristics and incidence of postoperative delirium with cognitive trajectory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 560 participants, 326 were women (58%) and the average age was 76.7 (standard deviation 5.2) years. They underwent orthopedic (81%), gastrointestinal (13%), and vascular surgeries (6%), and 24% experienced postoperative delirium. We found the 3\u2010group cognitive trajectory model to be optimal, with the groups characterized as severe decline trajectory (SDT) (15% of the cohort), slight decline (59%), or stable (26%). Of pre\u2010surgical factors, age (relative risk [RR]: 1.06, 95% confidence interval [CI] 1.03\u20131.10 per 1\u2009year increase) and 3MS (Modified\u2010Mini\u2010Mental) score (RR 0.95, 95% CI 0.92\u20130.99 per one point increase) were significantly associated with SDT. Participants who developed delirium had over two\u2010fold higher risk of SDT compared to those who did not (RR: 2.15, 95% CI: 1.35\u20133.42).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among older adults undergoing major surgery, 15% experienced severe cognitive decline over the ensuing 6\u2009years, 59% experienced slight decline, and 26% remained stable. Older age, baseline cognitive impairment, and delirium were associated with severe decline, with delirium having the strongest association. Our findings provide valuable information for older patients considering major surgery and may help clinicians target interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70434","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T13:40:42Z","timestamp":1778938842000},"page":"1901-1909","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cognitive Trajectories After Major Surgery in Older Adults and Factors Associated With Severe Decline"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5646-0546","authenticated-orcid":false,"given":"Nancy","family":"Lu","sequence":"first","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Psychiatry Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3466-7589","authenticated-orcid":false,"given":"Zachary J.","family":"Kunicki","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Human Behavior, Warren Alpert Medical School Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1049-218X","authenticated-orcid":false,"given":"Richard N.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Human Behavior, Warren Alpert Medical School Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6632-046X","authenticated-orcid":false,"given":"Sarinnapha M.","family":"Vasunilashorn","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of General Medicine, Department of Medicine Beth Israel Deaconess Medical Center  Boston Massachusetts USA"},{"name":"Department of Epidemiology Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3663-2937","authenticated-orcid":false,"given":"Sharon K.","family":"Inouye","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Marcus Institute for Aging Research  Boston Massachusetts USA"},{"name":"Division of Gerontology, Department of Medicine Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8975-0382","authenticated-orcid":false,"given":"Alvaro","family":"Pascual\u2010Leone","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Marcus Institute for Aging Research  Boston Massachusetts USA"},{"name":"Department of Neurology Beth Israel Deaconess Medical Center  Boston Massachusetts USA"},{"name":"Department of Neurology Harvard Medical School  Boston Massachusetts USA"},{"name":"Deanna and Sidney Wolk Center for Memory Heath Hebrew Senior Life, Boston  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8355-7047","authenticated-orcid":false,"given":"Tamara G.","family":"Fong","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Marcus Institute for Aging Research  Boston Massachusetts USA"},{"name":"Department of Neurology Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7665-4540","authenticated-orcid":false,"given":"Eran","family":"Metzger","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Psychiatry Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4006-8179","authenticated-orcid":false,"given":"Towia","family":"Libermann","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1030-7175","authenticated-orcid":false,"given":"Thomas G.","family":"Travison","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Marcus Institute for Aging Research  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2911-4250","authenticated-orcid":false,"given":"Edward R.","family":"Marcantonio","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of General Medicine, Department of Medicine Beth Israel Deaconess Medical Center  Boston Massachusetts USA"},{"name":"Division of Gerontology, Department of Medicine Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9349-7981","authenticated-orcid":false,"given":"Long H.","family":"Ngo","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of General Medicine, Department of Medicine Beth Israel Deaconess Medical Center  Boston Massachusetts USA"},{"name":"Department of Biostatistics Harvard T.H. 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