Risk of Dementia in Gastric Cancer Survivors Who Underwent Gastrectomy: A Nationwide Study in Korea

  • Yoon Jin Choi
  • Dong Wook ShinEmail author
  • Wooyoung Jang
  • Dong Ho Lee
  • Su-Min Jeong
  • Sanghyun Park
  • Kyung-do Han
  • Yong Gyu ParkEmail author
Health Services Research and Global Oncology



This study was designed to compare the risk of dementia, including Alzheimer’s disease (AD) and vascular dementia (VaD), between gastric cancer patients who underwent gastrectomy and the general population.


All patients (n = 63,998) aged ≥ 50 years who received a diagnosis of gastric cancer and underwent curative gastrectomy between 2007 and 2012 and a noncancer control population (n = 203,276), matched by age and sex, were identified from the Korean National Health Insurance Services and traced until 2017. Hazard ratios and 95% confidence intervals for dementia were calculated with a Cox regression analysis.


Gastric cancer patients who received a gastrectomy showed an increased risk of AD [adjusted hazard ration (aHR) 1.08, 95% confidence interval (CI) 1.03–1.14], and the risk was especially marked for those who received a total gastrectomy (aHR 1.39, 95% CI 1.25–1.54). Gastric cancer survivors showed a decreased risk for VaD (aHR 0.85; 95% CI 0.73–0.98) regardless of operation type. Those who received continual vitamin B12 supplementation after a total gastrectomy were less likely than controls to develop AD (aHR 0.71; 95% CI 0.54–0.92).


Compared with controls, gastric cancer patients who received a total gastrectomy had an increased incidence of AD and a decreased risk of VaD. Our results suggest that vitamin B12 deficiency might play a role in the development of AD and highlight the need for vitamin B12 supplementation after total gastrectomy.



This study received general research support from Samsung Medical Center.

Authors Contribution

SDW and PYG designed the study. HKD and PS analyzed the data. CYJ, JW, and JS drafted the manuscript. LDH and PYG revised the article. All the authors read and revised the manuscript and approved its final version. SDW and PYG are responsible for the overall content as guarantors and accept full responsibility for the work and conduct of the study; they had access to all the data and controlled the decision to publish. The corresponding authors attest that all listed authors meet the authorship criteria and that no others meeting the criteria have been omitted, that they had full access to all the data in the study, and that they had final responsibility for the decision to submit for publication.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


No authors have conflicts of interest to report.

Research Involving Human Participants

The research committee of Helsinki University Hospital approved our study plan. Obtaining consent was not needed in our register-based study, because we did not contact any study patients or their caregivers.


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Yoon Jin Choi
    • 1
  • Dong Wook Shin
    • 2
    Email author
  • Wooyoung Jang
    • 3
  • Dong Ho Lee
    • 1
  • Su-Min Jeong
    • 4
  • Sanghyun Park
    • 5
  • Kyung-do Han
    • 5
  • Yong Gyu Park
    • 5
    Email author
  1. 1.Department of Internal MedicineSeoul National University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Family Medicine and Supportive Care Center, Samsung Comprehensive Cancer Center, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  3. 3.Department of Neurology, Gangneung Asan HospitalUniversity of Ulsan College of MedicineGangneungRepublic of Korea
  4. 4.Department of Family MedicineSeoul Metropolitan Government-Seoul National University Boramae Medical CenterSeoulRepublic of Korea
  5. 5.Department of BiostatisticsThe Catholic University of KoreaSeoulRepublic of Korea

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