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. 2019 Apr;15(4):534-542.
doi: 10.1016/j.jalz.2018.12.005. Epub 2019 Feb 15.

Hospitalization, surgery, and incident dementia

Lars I Eriksson  1 , Cecilia Lundholm  2 , Kaavya Narasimhalu  2 , Rolf Sandin  3 , Ya-Ping Jin  4 , Margaret Gatz  5 , Nancy L Pedersen  6
Affiliations

Hospitalization, surgery, and incident dementia

Lars I Eriksson et al. Alzheimers Dement. 2019 Apr.

Abstract

Introduction: We evaluated whether hospitalization with or without surgery increases risk for dementia or Alzheimer's disease.

Methods: A clinical sample (843 clinically diagnosed dementia cases; 1686 matched nondemented individuals) was identified from Swedish Twin Registry studies. A register-based sample (4293 cases; 21,465 matched controls) was identified by linkage of Swedish Twin Registry to Swedish Patient Registry records. Apolipoprotein E (APOE) status and within-pair comparisons of dementia discordant twins indicated genetic susceptibility.

Results: Nonsurgical hospitalization is associated with greater dementia risk than hospitalization with surgical intervention. In the register sample, thoracic, abdominal, and major orthopedic procedures entailed dementia risk; in the clinical sample, orthopedic alone. Within-pair analyses indicate that associations in part reflect genetic susceptibility in common to hospitalization and dementia. Potential gene-environment interactions were indicated by greater risk due to hospitalization among APOE ε4 noncarriers.

Discussion: We confirm hospitalization as a risk factor for dementia, with repeated hospitalizations a more important risk factor than surgery.

Keywords: APOE; Alzheimer's disease; Co-twin control; Dementia; Hospitalization; Nested case-control; Surgery.

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Conflict of interest statement

Declaration of interests

The authors declare no competing interests.

Figures

Figure 1.
Figure 1.. Risk of dementia and AD as a function of number of non-surgical and surgical hospitalizations.
Nested case control analyses showing hazard ratios and 95% confidence intervals and p-values from trend tests for dementia and AD by number of hospitalizations and type of hospitalization (non-surgical vs no non-surgical hospitalization (■) and surgical vs no surgical hospitalization (▲)), all adjusted for education, sex and birth year. Left panel is based on all dementia cases and right panel on AD cases only, with respective controls.
Figure 2.
Figure 2.. Risk of dementia by age at hospitalization and time from hospitalization to dementia.
Nested case control analyses showing hazard ratios and 95% confidence intervals for dementia by age at hospitalization and time from hospitalization to dementia in years by type of hospitalization (non-surgical vs no non-surgical hospitalization (■) and surgical vs no surgical hospitalization (▲)), all adjusted for education, sex and birth year. Age at hospitalization was defined as age on day of admission to hospital.
Figure 3.
Figure 3.. Relative risks of dementia by number and type of hospitalization in twins with co-twin as control.
Analyses using co-twin as control in register-based sample, with hazard ratios and 95% confidence intervals for dementia by number of hospitalizations and type of hospitalization, i.e. non-surgical vs no non-surgical hospitalization (■) and surgical vs no surgical hospitalization (▲), all adjusted for education, sex and birth year.
See this image and copyright information in PMC

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