{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T02:31:57Z","timestamp":1788402717556,"version":"build-2803163510"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T00:00:00Z","timestamp":1717372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006578","name":"Chi Mei Medical Center","doi-asserted-by":"publisher","award":["CMOR11203"],"award-info":[{"award-number":["CMOR11203"]}],"id":[{"id":"10.13039\/501100006578","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Dementia is a gradual and ongoing cognitive decline due to damage to nerve cells in the brain. This meta-analysis aimed to assess the potential relationship between regional anesthesia (RA) and the risk of dementia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Electronic databases including Embase, Medline, Google Scholar, and Cochrane Library were searched for studies investigating the association between RA and dementia risk from inception to March 2022. The primary outcome was the risk of dementia in patients who underwent RA (RA group) and those who received general anesthesia (GA group). Secondary outcomes included identifying other potential risk factors for dementia and comparing dementia risk between individuals receiving RA and those not receiving surgery\/anesthesia (placebo group).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight cohort studies published between 2014 and 2023 were included in this analysis. A meta-analysis of the available data demonstrated no differences in baseline characteristics and morbidities (i.e., age, male proportion, hypertension, diabetes, depression, and severe comorbidities) between the RA and GA groups (all <jats:italic>p<\/jats:italic>\u2009&amp;gt;\u20090.05). Initial analysis revealed that the risk of dementia was higher in the GA group than in the RA group (HR\u2009=\u20091.81, 95% CI\u2009=\u20091.29\u20132.55, <jats:italic>p<\/jats:italic>\u2009=\u20090.007, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> =\u200999%, five studies). However, when a study featuring a relatively younger population was excluded from the sensitivity analysis, the results showed a similar risk of dementia (HR, 1.17; <jats:italic>p<\/jats:italic>\u2009=\u20090.13) between the GA and RA groups. The pooled results revealed no difference in dementia risk between the RA and placebo groups (HR\u2009=\u20091.2, 95% CI\u2009=\u20090.69\u20132.07, <jats:italic>p<\/jats:italic>\u2009=\u20090.52, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> =\u200968%, three studies). Sensitivity analysis revealed that the evidence was not stable, suggesting that limited datasets precluded strong conclusions on this outcome. Anxiety, stroke history, hypertension, diabetes, hyperlipidemia, and diabetes are potential predictors of dementia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our results emphasize that, while RA could be protective against dementia risk compared to GA, the association between the type of anesthesia and dementia risk might vary among different age groups. Owing to the significant prevalence of dementia among older people and their surgical needs, further investigations are warranted to clarify the association between dementia risk and regional anesthesia.<\/jats:p><jats:p><jats:bold>Systematic review registration<\/jats:bold>: <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>, CRD42023411324.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1362461","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T17:15:44Z","timestamp":1717434944000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Comparison of regional vs. general anesthesia on the risk of dementia: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"I-Wen","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheuk-Kwan","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jen-Yin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiao-Tien","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo-Mao","family":"Lan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo-Chuan","family":"Hung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching-Chung","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,6,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/S1474-4422(05)70286-6","article-title":"A life-course approach to the aetiology of late-onset dementias","volume":"5","author":"Whalley","year":"2006","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1001\/jama.2019.4782","article-title":"Diagnosis and management of dementia","volume":"322","author":"Arvanitakis","year":"2019","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1111\/imj.12572","article-title":"Dementia in older people: an update","volume":"44","author":"LoGiudice","year":"2014","journal-title":"Intern Med J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1093\/ageing\/26.suppl_2.3","article-title":"Nursing homes in 10 nations: a comparison between countries and settings","volume":"26","author":"Ribbe","year":"1997","journal-title":"Age Ageing"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/S0140-6736(20)30367-6","article-title":"Dementia prevention, intervention, and care: 2020 report of the lancet commission","volume":"396","author":"Livingston","year":"2020","journal-title":"Lancet"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1002\/gps.2610","article-title":"The economic impact of dementia in Europe in 2008\u2014cost estimates from the Eurocode project","volume":"26","author":"Wimo","year":"2011","journal-title":"Int J Geriatr Psychiatry"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2046","DOI":"10.1016\/j.jamda.2021.06.012","article-title":"Factors associated with emergency department visits by people with dementia near the end of life: a systematic review","volume":"22","author":"Williamson","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1177\/1471301216653537","article-title":"Family caregivers\u2019 reports of hospitalizations and emergency department visits in community-dwelling individuals with dementia","volume":"17","author":"Benner","year":"2018","journal-title":"Dementia"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1097\/01.SLA.0000081085.98792.3d","article-title":"The aging population and its impact on the surgery workforce","volume":"238","author":"Etzioni","year":"2003","journal-title":"Ann Surg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1007\/s00264-006-0130-y","article-title":"Obesity increases the likelihood of total joint replacement surgery among younger adults","volume":"31","author":"Harms","year":"2007","journal-title":"Int Orthop"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1054\/arth.2002.30414","article-title":"Changing incidence of primary total hip arthroplasty and total knee arthroplasty for primary osteoarthritis","volume":"17","author":"Wells","year":"2002","journal-title":"J Arthroplast"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1080\/17453674.2018.1446463","article-title":"Projections of primary hip arthroplasty in Germany until 2040","volume":"89","author":"Pilz","year":"2018","journal-title":"Acta Orthop"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/3234013","article-title":"Relationship between surgery under general anesthesia and the development of dementia: a systematic review and meta-analysis","volume":"2020","author":"Lee","year":"2020","journal-title":"Biomed Res Int"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1192\/bjp.bp.112.119610","article-title":"Risk of dementia after anaesthesia and surgery","volume":"204","author":"Chen","year":"2014","journal-title":"Br J Psychiatry"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1111\/aas.13302","article-title":"Is there a relationship between anaesthesia and dementia?","volume":"63","author":"Strand","year":"2019","journal-title":"Acta Anaesthesiol Scand"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1111\/jgs.14024","article-title":"Anesthesia exposure and risk of dementia and Alzheimer's disease: a prospective study","volume":"64","author":"Aiello Bowles","year":"2016","journal-title":"J Am Geriatr Soc"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1097\/JCMA.0000000000000286","article-title":"Risk assessment of dementia after hysterectomy: analysis of 14-year data from the National Health Insurance Research Database in Taiwan","volume":"83","author":"Chen","year":"2020","journal-title":"J Chin Med Assoc"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1386","DOI":"10.3390\/jpm11121386","article-title":"Risk of dementia in patients who underwent surgery under neuraxial anesthesia: a nationwide cohort study","volume":"11","author":"Kwon","year":"2021","journal-title":"J Personal Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.bja.2022.11.014","article-title":"Dementia risk amongst older adults with hip fracture receiving general anaesthesia or regional anaesthesia: a propensity-score-matched population-based cohort study","volume":"130","author":"Sun","year":"2023","journal-title":"Br J Anaesth"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"101727","DOI":"10.1016\/j.eclinm.2022.101727","article-title":"Dementia risk after major elective surgery based on the route of anaesthesia: a propensity score-matched population-based cohort study","volume":"55","author":"Sun","year":"2023","journal-title":"EClinicalMedicine"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1111\/jgs.16834","article-title":"Association between exposure to general versus regional anesthesia and risk of dementia in older adults","volume":"69","author":"Velkers","year":"2021","journal-title":"J Am Geriatr Soc"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1016\/j.bja.2021.07.021","article-title":"Anaesthetic depth and delirium after major surgery: a randomised clinical trial","volume":"127","author":"Evered","year":"2021","journal-title":"Br J Anaesth"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1034\/j.1399-6576.2003.00057.x","article-title":"Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients","volume":"47","author":"Rasmussen","year":"2003","journal-title":"Acta Anaesthesiol Scand"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1001\/jama.2021.22647","article-title":"Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery: the RAGA randomized trial","volume":"327","author":"Li","year":"2022","journal-title":"JAMA"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"106854","DOI":"10.1016\/j.ijsu.2022.106854","article-title":"The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery: a systematic review and meta-analysis","volume":"105","author":"Bhushan","year":"2022","journal-title":"Int J Surg"},{"key":"ref27","first-page":"781","article-title":"The impact of postoperative pain on the development of postoperative delirium","volume":"86","author":"Lynch","year":"1998","journal-title":"Anesth Analg"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1213\/01.ane.0000199156.59226.af","article-title":"Postoperative delirium: the importance of pain and pain management","volume":"102","author":"Vaurio","year":"2006","journal-title":"Anesth Analg"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1001\/archneurol.2009.48","article-title":"The common inhalational anesthetic sevoflurane induces apoptosis and increases beta-amyloid protein levels","volume":"66","author":"Dong","year":"2009","journal-title":"Arch Neurol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1097\/00000542-200605000-00015","article-title":"The common inhalation anesthetic isoflurane induces apoptosis and increases amyloid beta protein levels","volume":"104","author":"Xie","year":"2006","journal-title":"Anesthesiology"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1097\/00000542-200409000-00019","article-title":"Inhaled anesthetic enhancement of amyloid-beta oligomerization and cytotoxicity","volume":"101","author":"Eckenhoff","year":"2004","journal-title":"Anesthesiology"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.3233\/JAD-2010-1318","article-title":"Anesthesia with isoflurane increases amyloid pathology in mice models of Alzheimer's disease","volume":"19","author":"Perucho","year":"2010","journal-title":"J Alzheimer's Dis"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1186\/1471-2318-11-83","article-title":"Exposure to general anesthesia and risk of Alzheimer's disease: a systematic review and meta-analysis","volume":"11","author":"Seitz","year":"2011","journal-title":"BMC Geriatr"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/S1474-4422(11)70072-2","article-title":"The projected effect of risk factor reduction on Alzheimer's disease prevalence","volume":"10","author":"Barnes","year":"2011","journal-title":"Lancet Neurol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2028","DOI":"10.1001\/jama.2017.2247","article-title":"Reducing risk of dementia in older age","volume":"317","author":"Sabayan","year":"2017","journal-title":"JAMA"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1778","DOI":"10.1212\/WNL.0b013e31828726f5","article-title":"Alzheimer disease in the United States (2010-2050) estimated using the 2010 census","volume":"80","author":"Hebert","year":"2013","journal-title":"Neurology"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.1002\/alz.13016","article-title":"2023 Alzheimer's disease facts and figures","volume":"19","year":"2023","journal-title":"Alzheimers Dement"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"13620","DOI":"10.1038\/s41598-022-18033-x","article-title":"Protective effect of apolipoprotein E epsilon 3 on sporadic Alzheimer's disease in the Chinese population: a meta-analysis","volume":"12","author":"Chen","year":"2022","journal-title":"Sci Rep"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1016\/S0929-6646(09)60402-2","article-title":"Risk factors for dementia","volume":"108","author":"Chen","year":"2009","journal-title":"J Formos Med Assoc"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e242","DOI":"10.1212\/WNL.0000000000201419","article-title":"Air pollution and incidence of dementia: a systematic review and meta-analysis","volume":"100","author":"Abolhasani","year":"2023","journal-title":"Neurology"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1177\/1533317514531443","article-title":"Association of apolipoprotein E genetic variation in Alzheimer's disease in Indian population: a meta-analysis","volume":"29","author":"Agarwal","year":"2014","journal-title":"Am J Alzheimers Dis Other Dement"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1992","DOI":"10.1212\/WNL.53.9.1992","article-title":"Gender differences in the incidence of AD and vascular dementia: the EURODEM studies. EURODEM incidence research group","volume":"53","author":"Andersen","year":"1999","journal-title":"Neurology"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1016\/S0197-4580(01)00231-7","article-title":"Incidence of dementia: does gender make a difference?","volume":"22","author":"Ruitenberg","year":"2001","journal-title":"Neurobiol Aging"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1159\/000078502","article-title":"Incidence of dementia in a rural community in Spain: the Girona cohort study","volume":"23","author":"L\u00f3pez-Pousa","year":"2004","journal-title":"Neuroepidemiology"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1212\/01.WNL.0000160107.02316.BF","article-title":"Incidence and etiology of dementia in a large elderly Italian population","volume":"64","author":"Ravaglia","year":"2005","journal-title":"Neurology"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1362461\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T10:18:28Z","timestamp":1721384308000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1362461\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,3]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2024.1362461"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1362461","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,3]]},"article-number":"1362461"}}