By Amy Orciari Herman
Roughly 1 in 14 older adults undergoing noncardiac surgery experiences a perioperative covert stroke, and these patients face increased risk for cognitive decline, according to an international study in The Lancet.
Over 1000 adults aged 65 and older undergoing elective, noncardiac surgery had cognitive assessments before their surgery, brain MRI 2 to 9 days after surgery, and then repeat cognitive assessments at 1 year. MRI identified covert stroke in 7% of participants.
Cognitive decline at 1 year — defined as a 2-point drop on the 30-point Montreal Cognitive Assessment — occurred in 42% of patients who had a covert stroke and 29% who did not. After multivariable adjustment, covert stroke was associated with a twofold increase in risk for cognitive decline. Risk for perioperative delirium was also doubled in those with covert stroke.