Does General Anesthesia Increase the Risk of Dementia? – June 2025 Newsletter
Does General Anesthesia Increase the Risk of Dementia?
Hello, this is Dr. Ellen. In this month’s ‘Real Common Sense’ newsletter, I want to take a look at an issue that has concerned a number of my patients, particularly older adults. Especially over the past few years, the potential of general anesthesia increasing the risk of subsequent dementia, including Alzheimer’s disease, has been brought up. This is particularly concerning for those who will be receiving elective surgeries or more invasive diagnostic procedures. As our global population increases in number and average age, this has become an even more important subject to look at.
By the way, if you haven’t had a chance to see my previous newsletters, you can find them on my website, www.drellencutler.com under ‘Media’.
Is there an association between general anesthesia and the risk of dementia?
Does the use of general anesthesia increase the risk of developing dementia? Some recent studies do suggest an association between the two.(1,2) However, other studies have not.(3) What about the comparison between general and regional anesthesia? Again, some studies have found a higher incidence of dementia among those undergoing general anesthesia than in those receiving regional (spinal and/or epidural) anesthesia, and that those undergoing inhalation general anesthesia had a higher risk of dementia than those receiving non-inhalation anesthesia.(4) And a recently published study showed evidence that prolonged exposure to general anesthesia may contribute to long-term cognitive decline, though age and education were the two primary factors impacting lifetime cognitive decline.(5) On the other hand, another study found no difference in the risk of being diagnosed with dementia for individuals undergoing elective surgery who received general anesthesia when compared with those receiving regional anesthesia.(6)
Other possible post-operative neurological disturbances can also occur. For example, postoperative delirium is one of the most common complications of surgery for older adults. Sometimes mistaken for dementia, symptoms can include agitation, delusions, and rapid mood swings, Fortunately, in most cases, symptoms subside in a week or less. However, the condition can last for weeks or months in those with a history of cognitive dysfunctions such as dementia, vision or hearing impairment, or a history of post-operative delirium.(7) In a discussion on the subject,(8) the reviewer felt that although several studies have suggested an association between post-operative delirium and subsequent cognitive dysfunction, research does not suggest a strong correlation between post-operative delirium and rapidly progressive dementia in otherwise healthy patients.
Another recognized complication is post-operative cognitive dysfunction (POCD). It is a condition in which there is cognitive impairment (problems with memory, focus, and attention) lasting for days, weeks, or months following anesthesia. A study published in 2013 done over an average follow-up of 11 years found that POCD was not significantly associated with dementia.(9)
What should we make out of all of this?
The above points out the difficulty in determining if there is a definite association (let alone causation) between general anesthesia and the development of dementia. In addition to general anesthesia, other factors may be at least contributory to the risk of developing dementia. Surgeries themselves may curtail blood flow to the brain, leading to subsequent cognitive effects. Surgeries also lead to inflammation, which may send inflammatory chemicals and cells into the brain. The type of surgery performed can also have an effect. For example, cognitive problems are typically more common in heart surgery patients. Also, preexisting conditions, which may themselves have led to the need for the surgery, may have already caused damage to the brain before any operation, predisposing the patient to dementia.(10)
Studies that would provide the strongest evidence for a definitive link between general anesthesia and cognitive decline would require randomization of the subjects into test and control groups, ideally with the subjects being unaware of which group they were in. This would be nearly impossible to arrange because of logistical and ethical reasons. Researchers have had to rely on weaker evidence, often based on patients with different surgical histories.(10)
The Alzheimer Society of the U.K. feels that “There is currently no strong evidence to say that general anesthetics increase a person’s risk of developing dementia.” They state that in
“rare cases”, memory and thinking problems can persist and may lead to the diagnosis of dementia, but further state that this is attributable to underlying or undiagnosed cognitive problems.(11)
Some thoughts
The use of general anesthesia has certainly allowed both the development of major surgical interventions and for their wide availability. In many cases, these are the only alternative for the patient and can be life-saving. The extent to which general anesthesia can lead to dementia is not clear, but remains a possible sequela of its use. However, the risk-vs.-benefit ratio is often in favor of its use. There are situations, including some elective surgeries and diagnostic procedures, in which alternatives can be considered, such as so-called ‘twilight sedation’ (the deepest of which induces sleep with little or no memory of the procedure), regional sedation, and/or local anesthesia. But even in these cases it is best to discuss the available alternatives with the anesthesiologist and/or surgeon.
Excluding some acute situations, it is of course best to decrease the need for surgeries as best as one can. A healthy lifestyle can help decrease the incidence and/or severity of many metabolic and inflammatory disorders, including cardiovascular disease. Chief among the healthy choices are adequate and healthy exercise and physical activity, stress reduction, and a healthful diet. I have consistently found that a whole food plant-based diet is optimal. It is itself anti-inflammatory and has been repeatedly found to be metabolically healing. I also recommend to my patients that they use a high-quality full spectrum digestive enzyme blend at the beginning of each meal in order to optimize the digestion and absorption of nutrients. I recommend ECM ‘Digest Supreme’ or ECM ‘G.I. Calm’, the latter for those with gastrointestinal complaints. For those specifically with uncomfortable excess gas causing bloating and flatulence, I recommend ECM GasEnd Supreme.(12,13)
I have had a number of opportunities to help patients facing an elective procedure that requires anesthesia. I use the Ellen Cutler Method (ECM) to energetically identify and then desensitize reactivities related to each patient’s health status and any surgical/anesthetic intervention to optimize their health and wellness. When an option, I usually find in my testing that the use of the method with the greatest “consciousness-sparing” effect is best for the patient.
Till next month, please be well, be healthy, and remember…
“Cutting out bad habits is far more effective than cutting out organs.”
―Herbert M. Shelton
Dr. Ellen
References:
“Longitudinal Study of the Association between General Anesthesia and Increased Risk of Developing Dementia” at https://www.mdpi.com/2075-4426/11/11/1215
“Prospective association of general anesthesia with risk of cognitive decline in a Chinese elderly community population” at https://www.nature.com/articles/s41598-023-39300-5
“Mild Cognitive Impairment and Exposure to General Anesthesia for Surgeries and Procedures: A Population-Based Case–Control Study” at https://journals.lww.com/anesthesia-analgesia/abstract/2017/04000/mild_cognitive_impairment_and_exposure_to_general.38.aspx
“Dementia risk after major elective surgery based on the route of anaesthesia: a propensity score-matched population-based cohort study” at https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00457-6/fulltext
“Anaesthesia as a risk factor for long-term cognitive decline – Results of the prospective MAAS cohort study” at https://journals.lww.com/ejanaesthesiology/fulltext/2025/05000/anaesthesia_as_a_risk_factor_for_long_term.11.aspx?context=featuredarticles&collectionid=3
“Association Between Exposure to General Versus Regional Anesthesia and Risk of Dementia in Older Adults” at https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16834
“Postoperative delirium in seniors: Recognizing the symptoms, reducing the risks” at https://utswmed.org/medblog/postoperative-delirium-seniors-recognizing-symptoms-reducing-risks/
“What drives post-surgical delirium risk among older patients” at https://www.ama-assn.org/delivering-care/population-care/what-drives-post-surgical-delirium-risk-among-older-patients
“Is postoperative cognitive dysfunction a risk factor for dementia? A cohort follow-up study” at https://academic.oup.com/bja/article/110/suppl_1/i92/263482
“Will surgery sap your brain power?” at https://www.science.org/content/article/will-surgery-sap-your-brain-power
“General anaesthetic and the risk of dementia” at https://www.alzheimers.org.uk/about-dementia/managing-the-risk-of-dementia/possible-risks-of-dementia/general-anaesthetic
“News about Digestive Enzymes” at https://drellencutler.com/december-2022-newsletter/
“A New Supplement for Gas and Bloating” at https://drellencutler.com/a-new-supplement-for-gas-and-bloating-ecm-gasend-supreme-february-2025-newsletter/
* These statements have not been evaluated by the Food and Drug Administration. This information and the products discussed are not intended to diagnose, treat, cure, mitigate, or prevent any disease.
