The Postoperative Effects of Anesthesia Exposure on Cognitive Decline in Older Adults: A Narrative Review


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Abstract

Background::As modern medicine continues to make strides in effective surgical treatments, we must also consider the critical impact of anesthesia on neuropsychological outcomes. Recent evidence suggests that anesthesia exposure may be a risk factor for postoperative cognitive decline and the eventual development of dementia.

Objectives::To explore the vulnerability of the aging brain in the context of anesthesia exposure in surgery, studies will be reviewed, and pertinent findings will be highlighted and explored to better understand risks and possible factors that need to be considered when contemplating surgery. Methods: A narrative review was conducted using a combination of MEDLINE and APA PsycINFO databases to shed light on themes across studies assessing general trends regarding the influence of anesthesia on postoperative cognitive decline.

Results::A search of relevant literature identified 388 articles. Excluding results outside the parameters of this study, the review includes quality assessments for 24 articles.

Conclusion::While findings are inconclusive, suggestions for further investigation into the relationship between anesthesia exposure and increased risk for postoperative cognitive decline are discussed, in addition to factors that may allow for greater informed disclosure of potential risks of anesthesia in older adults.

About the authors

Kathleen Angela Willoughby-Dudley

Psychology, Colorado State University

Email: info@benthamscience.net

Marielle Darwin

Department of Psychology, Colorado State University

Email: info@benthamscience.net

Deana Davalos

Department of Psychology, Colorado State University

Author for correspondence.
Email: info@benthamscience.net

References

  1. Kim, C.T.; Myung, W.; Lewis, M.; Lee, H.; Kim, S.E.; Lee, K.; Lee, C.; Choi, J.; Kim, H.; Carroll, B.J.; Kim, D.K. Exposure to general anesthesia and risk of dementia: A nationwide population-based cohort study. J. Alzheimers Dis., 2018, 63(1), 395-405. doi: 10.3233/JAD-170951 PMID: 29614656
  2. Jiang, J.; Dong, Y.; Huang, W.; Bao, M. General anesthesia exposure and risk of dementia: A meta-analysis of epidemiological studies. Oncotarget, 2017, 8(35), 59628-59637. doi: 10.18632/oncotarget.19524 PMID: 28938666
  3. Evered, L.; Silbert, B.; Knopman, D.S.; Scott, D.A.; DeKosky, S.T.; Rasmussen, L.S.; Oh, E.S.; Crosby, G.; Berger, M.; Eckenhoff, R.G. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery—2018. Anesthesiology, 2018, 129(5), 872-879. doi: 10.1097/ALN.0000000000002334 PMID: 30325806
  4. Patel, D.; Lunn, A.D.; Smith, A.D.; Lehmann, D.J.; Dorrington, K.L. Cognitive decline in the elderly after surgery and anaesthesia: Results from the oxford project to investigate memory and ageing (OPTIMA) cohort. Anaesthesia, 2016, 71(10), 1144-1152. doi: 10.1111/anae.13571 PMID: 27501155
  5. Steinmetz, J.; Rasmussen, L.S. Anesthesia and the risk of dementia in the elderly. Presse Med., 2018, 47(4), e45-e51. doi: 10.1016/j.lpm.2018.03.013 PMID: 29661618
  6. O’ Brien, H.; Mohan, H.; Hare, C.O.; Reynolds, J.V.; Kenny, R.A. Mind over matter? the hidden epidemic of cognitive dysfunction in the older surgical patient. Ann. Surg., 2017, 265(4), 677-691. doi: 10.1097/SLA.0000000000001900 PMID: 27537541
  7. Velkers, C.; Berger, M.; Gill, S.S.; Eckenhoff, R.; Stuart, H.; Whitehead, M.; Austin, P.C.; Rochon, P.A.; Seitz, D. Association between exposure to general versus regional anesthesia and risk of dementia in older adults. J. Am. Geriatr. Soc., 2021, 69(1), 58-67. doi: 10.1111/jgs.16834 PMID: 33025584
  8. Dhesi, J.K.; Moppett, I.K. Anaesthesia and the older brain: What should we do? Anaesthesia, 2022, 77(S1), 8-10. doi: 10.1111/anae.15636 PMID: 35001379
  9. Jiang, J.; Jiang, H. Effect of the inhaled anesthetics isoflurane, sevoflurane and desflurane on the neuropathogenesis of Alzheimer’s disease (Review). Mol. Med. Rep., 2015, 12(1), 3-12. doi: 10.3892/mmr.2015.3424 PMID: 25738734
  10. Sun, M.; Chen, W.M.; Wu, S.Y.; Zhang, J. Dementia risk after major elective surgery based on the route of anaesthesia: A propensity score-matched population-based cohort study. EClinicalMedicine, 2023, 55, 101727. doi: 10.1016/j.eclinm.2022.101727 PMID: 36386032
  11. Bademosi, A.T.; Steeves, J.; Karunanithi, S.; Zalucki, O.H.; Gormal, R.S.; Liu, S.; Lauwers, E.; Verstreken, P.; Anggono, V.; Meunier, F.A.; van Swinderen, B. Trapping of syntaxin1a in presynaptic nanoclusters by a clinically relevant general anesthetic. Cell Rep., 2018, 22(2), 427-440. doi: 10.1016/j.celrep.2017.12.054 PMID: 29320738
  12. Kwon, Y.S.; Lee, S.H.; Kim, C.; Yu, H.; Sohn, J.H.; Lee, J.J.; Kim, D.K. Risk of dementia according to surgery type: A nationwide cohort study. J. Pers. Med., 2022, 12(3), 468. doi: 10.3390/jpm12030468 PMID: 35330467
  13. Kim, J.H.; Jung, H.; Lee, Y.; Sohn, J.H. Surgery performed under propofol anesthesia induces cognitive impairment and amyloid pathology in ApoE4 knock-in mouse model. Front. Aging Neurosci., 2021, 13, 658860. doi: 10.3389/fnagi.2021.658860 PMID: 33981208
  14. Steinmetz, J; Rasmussen, LS Long-term consequences of postoperative cognitive dysfunction. Anesthesiology, 2009, 110(3), 548-555.
  15. van Sinderen, K.; Schwarte, L.A.; Schober, P. Diagnostic criteria of postoperative cognitive dysfunction: A focused systematic review. Anesthesiol. Res. Pract., 2020, 2020, 1-13. doi: 10.1155/2020/7384394 PMID: 33281900
  16. Daiello, L.A.; Racine, A.M.; Yun Gou, R.; Marcantonio, E.R.; Xie, Z.; Kunze, L.J.; Vlassakov, K.V.; Inouye, S.K.; Jones, R.N.; Alsop, D.; Travison, T.; Arnold, S.; Cooper, Z.; Dickerson, B.; Fong, T.; Metzger, E.; Leone, P.A.; Schmitt, E.M.; Shafi, M.; Cavallari, M.; Dai, W.; Dillon, S.T.; McElhaney, J.; Guttmann, C.; Hshieh, T.; Kuchel, G.; Libermann, T.; Ngo, L.; Press, D.; Saczynski, J.; Vasunilashorn, S.; O’Connor, M.; Kimchi, E.; Strauss, J.; Wong, B.; Belkin, M.; Ayres, D.; Callery, M.; Pomposelli, F.; Wright, J.; Schermerhorn, M.; Abrantes, T.; Albuquerque, A.; Bertrand, S.; Brown, A.; Callahan, A.; D’Aquila, M.; Dowal, S.; Fox, M.; Gallagher, J.; Anna Gersten, R.; Hodara, A.; Helfand, B.; Inloes, J.; Kettell, J.; Kuczmarska, A.; Nee, J.; Nemeth, E.; Ochsner, L.; Palihnich, K.; Parisi, K.; Puelle, M.; Rastegar, S.; Vella, M.; Xu, G.; Bryan, M.; Guess, J.; Enghorn, D.; Gross, A.; Gou, Y.; Habtemariam, D.; Isaza, I.; Kosar, C.; Rockett, C.; Tommet, D.; Gruen, T.; Ross, M.; Tasker, K.; Gee, J.; Kolanowski, A.; Pisani, M.; de Rooij, S.; Rogers, S.; Studenski, S.; Stern, Y.; Whittemore, A.; Gottlieb, G.; Orav, J.; Sperling, R. Postoperative delirium and postoperative cognitive dysfunction. Anesthesiology, 2019, 131(3), 477-491. doi: 10.1097/ALN.0000000000002729 PMID: 31166241
  17. Davis, D.H.J.; Muniz-Terrera, G.; Keage, H.A.D.; Stephan, B.C.M.; Fleming, J.; Ince, P.G.; Matthews, F.E.; Cunningham, C.; Ely, E.W.; MacLullich, A.M.J.; Brayne, C. Association of delirium with cognitive decline in late life. JAMA Psychiatr., 2017, 74(3), 244-251. doi: 10.1001/jamapsychiatry.2016.3423 PMID: 28114436
  18. Devinney, MJ; Mathew, JP; Berger, M Postoperative delirium and postoperative cognitive dysfunction: Two sides of the same coin? Anesthesiology, 2018, 129, 389-391.
  19. PRB, Fact Sheet: Aging in the United States. Available from: https://www.prb.org/what-we-do/focus-areas/aging/
  20. Prince, M.J.; Wu, F.; Guo, Y.; Robledo, G.L.M.; O’Donnell, M.; Sullivan, R.; Yusuf, S. The burden of disease in older people and implications for health policy and practice. Lancet, 2015, 385(9967), 549-562. doi: 10.1016/S0140-6736(14)61347-7 PMID: 25468153
  21. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; Chou, R.; Glanville, J.; Grimshaw, J.M.; Hróbjartsson, A.; Lalu, M.M.; Li, T.; Loder, E.W.; Mayo-Wilson, E.; McDonald, S.; McGuinness, L.A.; Stewart, L.A.; Thomas, J.; Tricco, A.C.; Welch, V.A.; Whiting, P.; Moher, D. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 2021, 372(71), n71. doi: 10.1136/bmj.n71 PMID: 33782057
  22. Peisah, C. Practical geriatrics: Persistent postoperative cognitive decline in an elderly woman with preexisting neuropathology. Psychiatr. Serv., 2002, 53(3), 277-279. doi: 10.1176/appi.ps.53.3.277 PMID: 11875219
  23. Sprung, J.; Abcejo, A.S.A.; Knopman, D.S.; Petersen, R.C.; Mielke, M.M.; Hanson, A.C.; Schroeder, D.R.; Schulte, P.J.; Martin, D.P.; Weingarten, T.N.; Pasternak, J.J.; Warner, D.O. Anesthesia with and without nitrous oxide and long-term cognitive trajectories in older adults. Anesth. Analg., 2020, 131(2), 594-604. doi: 10.1213/ANE.0000000000004490 PMID: 31651458
  24. Bickel, H.; Gradinger, R.; Kochs, E.; Förstl, H. High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study. Dement. Geriatr. Cogn. Disord., 2008, 26(1), 26-31. doi: 10.1159/000140804 PMID: 18577850
  25. Sprung, J.; Roberts, R.O.; Weingarten, T.N.; Cavalcante, N.A.; Knopman, D.S.; Petersen, R.C.; Hanson, A.C.; Schroeder, D.R.; Warner, D.O. Postoperative delirium in elderly patients is associated with subsequent cognitive impairment. Br. J. Anaesth., 2017, 119(2), 316-323. doi: 10.1093/bja/aex130 PMID: 28854531
  26. Suraarunsumrit, P.; Pathonsmith, C.; Srinonprasert, V.; Sangarunakul, N.; Jiraphorncharas, C.; Siriussawakul, A. Postoperative cognitive dysfunction in older surgical patients associated with increased healthcare utilization: A prospective study from an upper-middle-income country. BMC Geriatr., 2022, 22(1), 213. doi: 10.1186/s12877-022-02873-3 PMID: 35296258
  27. Neufeld, K.J.; Leoutsakos, J.M.S.; Oh, E.; Sieber, F.E.; Chandra, A.; Ghosh, A.; Schretlen, D.J.; Needham, D.M. Long-term outcomes of older adults with and without delirium immediately after recovery from general anesthesia for surgery. Am. J. Geriatr. Psychiatry, 2015, 23(10), 1067-1074. doi: 10.1016/j.jagp.2015.03.004 PMID: 25912784
  28. Bowles, A.E.J.; Larson, E.B.; Pong, R.P.; Walker, R.L.; Anderson, M.L.; Yu, O.; Gray, S.L.; Crane, P.K.; Dublin, S. Anesthesia exposure and risk of dementia and alzheimer’s disease: A prospective study. J. Am. Geriatr. Soc., 2016, 64(3), 602-607. doi: 10.1111/jgs.14024 PMID: 26865152
  29. Ancelin, M.L.; De Roquefeuil, G.; Ledésert, B.; Bonnel, F.; Cheminal, J.C.; Ritchie, K. Exposure to anaesthetic agents, cognitive functioning and depressive symptomatology in the elderly. Br. J. Psychiatry, 2001, 178(4), 360-366. doi: 10.1192/bjp.178.4.360 PMID: 11282816
  30. Schulte, P.J.; Roberts, R.O.; Knopman, D.S.; Petersen, R.C.; Hanson, A.C.; Schroeder, D.R.; Weingarten, T.N.; Martin, D.P.; Warner, D.O.; Sprung, J. Association between exposure to anaesthesia and surgery and long-term cognitive trajectories in older adults: Report from the mayo clinic study of aging. Br. J. Anaesth., 2018, 121(2), 398-405. doi: 10.1016/j.bja.2018.05.060 PMID: 30032878
  31. Zhang, D.; Ying, J.; Ma, X.; Gao, Z.; Chen, H.; Zhu, S.; Shi, L.; Lu, X. Social cognitive dysfunction in elderly patients after anesthesia and surgery. Front. Psychol., 2020, 11, 541161. doi: 10.3389/fpsyg.2020.541161 PMID: 33071859
  32. Sprung, J.; Roberts, R.O.; Knopman, D.S.; Olive, D.M.; Gappa, J.L.; Sifuentes, V.L.; Behrend, T.L.; Farmer, J.D.; Weingarten, T.N.; Hanson, A.C.; Schroeder, D.R.; Petersen, R.C.; Warner, D.O. Association of mild cognitive impairment with exposure to general anesthesia for surgical and nonsurgical procedures. Mayo Clin. Proc., 2016, 91(2), 208-217. doi: 10.1016/j.mayocp.2015.10.023 PMID: 26803349
  33. Sprung, J.; Roberts, R.O.; Knopman, D.S.; Price, L.L.; Schulz, H.P.; Tatsuyama, C.L.; Weingarten, T.N.; Schroeder, D.R.; Hanson, A.C.; Petersen, R.C.; Warner, D.O. Mild cognitive impairment and exposure to general anesthesia for surgeries and procedures: A population-based case–control study. Anesth. Analg., 2017, 124(4), 1277-1290. doi: 10.1213/ANE.0000000000001725 PMID: 28291057
  34. Yoshimoto, A.; Inoue, T.; Morizumi, S.; Nishi, S.; Shimizu, T.; Kurahashi, K.; Suematsu, Y. Analysis of the perioperative change in cognitive function of patients with risk factors for cognitive impairment in cardiovascular surgery. Gen. Thorac. Cardiovasc. Surg., 2019, 67(2), 214-218. doi: 10.1007/s11748-018-0999-6 PMID: 30143959
  35. Fischer, P.; Wallner, H.; Jungwirth, S.; Weissgram, S.; Krampla, W.; Bauer, P.; Tragl, K.H. Cumulative exposure to general anesthesias and cognitive dysfunction at age 75 in the vienna transdanube aging "VITA" study. J. Neuropsychiatry Clin. Neurosci., 2007, 19(1), 21-26. doi: 10.1176/jnp.2007.19.1.21 PMID: 17308223
  36. Ackenbom, M.F.; Butters, M.A.; Davis, E.M.; Abebe, K.Z.; Baranski, L.; Zyczynski, H.M. Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgery. Int. Urogynecol. J. Pelvic Floor Dysfunct., 2021, 32(2), 433-442. doi: 10.1007/s00192-020-04495-y PMID: 32827107
  37. Sprung, J.; Schulte, P.J.; Knopman, D.S.; Mielke, M.M.; Petersen, R.C.; Weingarten, T.N.; Martin, D.P.; Hanson, A.C.; Schroeder, D.R.; Warner, D.O. Cognitive function after surgery with regional or general anesthesia: A population-based study. Alzheimers Dement., 2019, 15(10), 1243-1252. doi: 10.1016/j.jalz.2019.06.4949 PMID: 31495602
  38. Strand, A.K.; Nyqvist, F.; Ekdahl, A.; Wingren, G.; Eintrei, C. Is there a relationship between anaesthesia and dementia? Acta Anaesthesiol. Scand., 2019, 63(4), 440-447. doi: 10.1111/aas.13302 PMID: 30511411
  39. Xie, H.; Zhou, J.; Du, W.; Zhang, S.; Huang, R.; Han, Q.; Guo, Q. Impact of thoracic paravertebral block combined with general anesthesia on postoperative cognitive function and serum adiponectin levels in elderly patients undergoing lobectomy. Wideochir. Inne Tech. Malo Inwazyjne, 2019, 14(4), 538-544. doi: 10.5114/wiitm.2019.84742 PMID: 31908700
  40. Geng, Y.; Wu, Q.; Zhang, R. Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial. J. Clin. Anesth., 2017, 38, 165-171. doi: 10.1016/j.jclinane.2017.02.007 PMID: 28372661
  41. Chrisinger, A.A.; Avidan, M.S. Postoperative delirium portends descent to dementia. Br. J. Anaesth., 2017, 119(2), 285-288. doi: 10.1093/bja/aex126 PMID: 28854545
  42. Ishii, K.; Makita, T.; Yamashita, H.; Matsunaga, S.; Akiyama, D.; Toba, K.; Hara, K.; Sumikawa, K.; Hara, T. Total intravenous anesthesia with propofol is associated with a lower rate of postoperative delirium in comparison with sevoflurane anesthesia in elderly patients. J. Clin. Anesth., 2016, 33, 428-431. doi: 10.1016/j.jclinane.2016.04.043 PMID: 27555205
  43. Chan, C.S.; Chan, M.T.V. Use of nitrous oxide in contemporary anesthesia—an ongoing tug of war. Can. J. Anaesth., 2021, 68(11), 1597-1600. doi: 10.1007/s12630-021-02094-z PMID: 34448128
  44. Myles, P.S.; Chan, M.T.V.; Kaye, D.M.; McIlroy, D.R.; Lau, C.W.; Symons, J.A.; Chen, S. Effect of nitrous oxide anesthesia on plasma homocysteine and endothelial function. Anesthesiology, 2008, 109(4), 657-663. doi: 10.1097/ALN.0b013e31818629db PMID: 18813045
  45. Chen, Y.; Liu, X.; Cheng, C.H.K.; Gin, T.; Leslie, K.; Myles, P.; Chan, M.T.V. Leukocyte DNA damage and wound infection after nitrous oxide administration: A randomized controlled trial. Anesthesiology, 2013, 118(6), 1322-1331. doi: 10.1097/ALN.0b013e31829107b8 PMID: 23549382
  46. Leung, J.M.; Sands, L.P.; Vaurio, L.E.; Wang, Y. Nitrous oxide does not change the incidence of postoperative delirium or cognitive decline in elderly surgical patients. Br. J. Anaesth., 2006, 96(6), 754-760. doi: 10.1093/bja/ael106 PMID: 16670110
  47. Vacas, S.; Cole, D.J.; Cannesson, M. Cognitive decline associated with anesthesia and surgery in older patients. JAMA, 2021, 326(9), 863-864. doi: 10.1001/jama.2021.4773 PMID: 34338712
  48. Ding, D.; Wang, P.; Jiang, Y.; Zhang, X.; Shi, W.; Luo, Y. Effects of apolipoprotein Ε ε4 allele on early postoperative cognitive dysfunction after anesthesia. Anaesthesist, 2021, 70(S1), 60-67. doi: 10.1007/s00101-021-00972-1 PMID: 34143234
  49. Deiner, S.; Baxter, M.G.; Mincer, J.S.; Sano, M.; Hall, J.; Mohammed, I.; O’Bryant, S.; Zetterberg, H.; Blennow, K.; Eckenhoff, R. Human plasma biomarker responses to inhalational general anaesthesia without surgery. Br. J. Anaesth., 2020, 125(3), 282-290. doi: 10.1016/j.bja.2020.04.085 PMID: 32536445
  50. Baxter, M.G.; Mincer, J.S.; Brallier, J.W.; Schwartz, A.; Ahn, H.; Nir, T.; McCormick, P.J.; Ismail, M.; Sewell, M.; Allore, H.G.; Ramsey, C.M.; Sano, M.; Deiner, S.G. Cognitive recovery by decade in healthy 40- to 80-year-old volunteers after anesthesia without surgery. Anesth. Analg., 2022, 134(2), 389-399. doi: 10.1213/ANE.0000000000005824 PMID: 34889804
  51. Chen, L.; Au, E.; Saripella, A.; Kapoor, P.; Yan, E.; Wong, J.; Tang-Wai, D.F.; Gold, D.; Riazi, S.; Suen, C.; He, D.; Englesakis, M.; Nagappa, M.; Chung, F. Postoperative outcomes in older surgical patients with preoperative cognitive impairment: A systematic review and meta-analysis. J. Clin. Anesth., 2022, 80, 110883. doi: 10.1016/j.jclinane.2022.110883 PMID: 35623265
  52. Li, L.; Dohan, D.; Smith, A.K.; Whitlock, E.L. ‘It was a great brain, and I miss it’: Lay perspectives on postoperative cognitive dysfunction. Br. J. Anaesth., 2023, 130(5), 567-572. doi: 10.1016/j.bja.2023.02.003 PMID: 36868965
  53. Han, C.; Ji, H.; Guo, Y.; Fei, Y.; Wang, C.; Yuan, Y.; Ruan, Z.; Ma, T. Effect of subanesthetic dose of esketamine on perioperative neurocognitive disorders in elderly undergoing gastrointestinal surgery: A randomized controlled trial. Drug Des. Devel. Ther., 2023, 17, 863-873. doi: 10.2147/DDDT.S401161 PMID: 36974331
  54. Hu, L.; Luo, M.; Huang, H.; Wu, L.; Ouyang, W.; Tong, J.; Le, Y. Perioperative probiotics attenuates postoperative cognitive dysfunction in elderly patients undergoing hip or knee arthroplasty: A randomized, double-blind, and placebo-controlled trial. Front. Aging Neurosci., 2023, 14, 1037904. doi: 10.3389/fnagi.2022.1037904 PMID: 36688164
  55. Wang, P.; Yin, X.; Chen, G.; Li, L.; Le, Y.; Xie, Z.; Ouyang, W.; Tong, J. Perioperative probiotic treatment decreased the incidence of postoperative cognitive impairment in elderly patients following non-cardiac surgery: A randomised double-blind and placebo-controlled trial. Clin. Nutr., 2021, 40(1), 64-71. doi: 10.1016/j.clnu.2020.05.001 PMID: 32451125
  56. Olotu, C.; Ascone, L.; Wiede, J.; Manthey, J.; Kuehn, S.; Scherwath, A.; Kiefmann, R. The effect of delirium preventive measures on the occurrence of postoperative cognitive dysfunction in older adults undergoing cardiovascular surgery. The DelPOCD randomised controlled trial. J. Clin. Anesth., 2022, 78, 110686. doi: 10.1016/j.jclinane.2022.110686 PMID: 35190345
  57. Wasef, S.; Laksono, I.; Kapoor, P.; Tang-Wei, D.; Gold, D.; Saripella, A.; Riazi, S.; Islam, S.; Englesakis, M.; Wong, J.; Chung, F. Screening for subjective cognitive decline in the elderly via subjective cognitive complaints and informant-reported questionnaires: A systematic review. BMC Anesthesiol., 2021, 21(1), 277. doi: 10.1186/s12871-021-01493-5 PMID: 34753428
  58. Carter, J.; Story, D.A. Veterinary and human anaesthesia: An overview of some parallels and contrasts. Anaesth. Intensive Care, 2013, 41(6), 710-718. doi: 10.1177/0310057X1304100605 PMID: 24180711
  59. Drummond, E.; Wisniewski, T. Alzheimer’s disease: Rxperimental models and reality. Acta Neuropathol., 2017, 133(2), 155-175. doi: 10.1007/s00401-016-1662-x PMID: 28025715
  60. Cho, S.A.; Lee, S.J.; Sung, T.Y.; Kim, D.K.; Cho, C.K. Comparative analysis of anesthetic legal disputes between older and younger patients referred to the korean society of anesthesiologists in 2009–2018. Ann Geriatr Med Res, 2019, 23(4), 204-211. doi: 10.4235/agmr.19.0026 PMID: 32743313

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