Is General Anesthesia Linked to Long-Term Cognitive Decline? 

A new prospective cohort study published in the European Journal of Anaesthesiology (2025) sheds important light on a long-debated topic: Can general anesthesia contribute to cognitive decline later in life? The Maastricht Aging Study (MAAS) provides compelling evidence that the answer may be yes, especially when combined with age and systemic health issues.

Background

Cognitive decline is a well-established phenomenon associated with aging. However, there has been growing concern that exposure to surgery under general anesthesia (GA) could accelerate this process, particularly among older adults undergoing multiple procedures.

• Perioperative neurocognitive disorders (PND) affect up to 63% of surgical patients.
• Past studies offered conflicting conclusions, partly due to short follow-ups or a lack of detailed exposure assessment.
• The MAAS study offers a 12-year longitudinal view with over 1,800 participants, capturing nuanced changes in cognitive performance.

Cognitive domains assessed

The study used validated tests to evaluate performance in:

• Executive function: Concept Shifting Test (CST) 
• Verbal memory: Visual Verbal Learning Test (VVLT) 
• Selective attention & mental speed: Stroop Colour Word Test 
• Information processing speed: Letter Digit Substitution Test (LDST)

Key findings

Cognitive decline associated with GA exposure

Increased time under GA at baseline correlated with a statistically significant decline in three out of four cognitive domains:

• Executive function (CST): Slower task completion 
• Elective attention (Stroop): Greater interference effects 
• Information processing (LDST): Fewer correct responses

Verbal memory was not significantly affected by anesthesia exposure alone.

Influencing factors

Other variables also played a strong role in cognitive outcomes:

• Age: Older individuals showed more pronounced decline.
• Education: Higher education appeared protective.
• Health Conditions:
  • Hypertension
  • Diabetes
  • Smoking history
  • Hypercholesterolemia
    

Implications for patients and providers

• Preoperative assessment should include cognitive risk discussions, especially in older adults. 
• Postoperative cognitive monitoring may help identify early signs of decline. 
• Consider minimally invasive or regional techniques when clinically appropriate. 
• Lifestyle interventions—controlling blood pressure, glucose, and cholesterol—remain critical for brain health.

Conclusion

This 12-year study provides solid evidence that prolonged exposure to general anesthesia may independently contribute to long-term cognitive decline, though to a lesser extent than aging and comorbidities. With populations aging and surgical needs rising, early recognition, preventive strategies, and interdisciplinary care are vital for preserving cognitive health.

Reference: Pennings CH. et al., Eur J Anaesthesiol. 2025;42(5):468-477. 

For more information on general anesthesia and cognitive decline,  check out Anesthesia Updates on the NYSORA Anesthesia Assistant App. 

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