Association of General Anesthesia Exposure with Cognitive Outcomes in Older Adults: A Cross-Sectional Study in a Korean Cohort

Background: The relationship between general anesthesia (GA) exposure and cognitive function remains controversial. This study aimed to investigate the association between GA exposure and cognitive severity, as measured using the Clinical Dementia Rating Sum of Boxes (CDR-SB) and Global Deterioration Scale (GDS), across different diagnostic groups. Methods: We used a de-identified dataset from the Korea Dementia Research Center’s Trial Ready Registry (KDRC TRR). Participants were classified as having normal cognition, mild cognitive impairment (MCI), or dementia. Logistic regression analyses were performed to identify the variables associated with CDR-SB and GDS scores within each group. Linear regression analyses were also performed for the amyloid positron emission tomography standardized uptake value ratios (SUVRs). Results: Among 688 participants, 258 were classified as having normal cognition, 245 as MCI, and 185 as dementia. In the normal group, GA exposure was associated with higher CDR-SB (OR = 2.33 [95% CI: 1.06–5.08, p = 0.032]) and GDS scores (OR = 2.29 [95% CI: 1.16–4.55, p = 0.017]). In addition, in this group, GA exposure was significantly associated with higher SUVRs in multivariable analyses (β = 0.09, 95% CI: 0.004–0.18, p = 0.040). No consistent associations were observed in the MCI or dementia groups. Conclusions: GA exposure after the age of 50 was associated with greater cognitive severity and higher amyloid burden in cognitively normal individuals. Prospective longitudinal studies incorporating detailed anesthetic, surgical, and perioperative data are required to clarify the nature of this association.