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The link between exposure to general anaesthesia and surgery (exposure) and cognitive decline in older adults is debated. We hypothesised that it is associated with cognitive decline.We analysed the longitudinal cognitive function trajectory in a cohort of older adults. Models assessed the rate of change in cognition over time, and its association with exposure to anaesthesia and surgery. Analyses assessed whether exposure in the 20 yr before enrolment is associated with cognitive decline when compared with those unexposed, and whether post-enrolment exposure is associated with a change in cognition in those unexposed before enrolment.We included 1819 subjects with median (25th and 75th percentiles) follow-up of 5.1 (2.7–7.6) yr and 4 (3–6) cognitive assessments. Exposure in the previous 20 yr was associated with a greater negative slope compared with not exposed (slope: –0.077 vs –0.059; difference: –0.018; 95% confidence interval: –0.032, –0.003; P=0.015). Post-enrolment exposure in those previously unexposed was associated with a change in slope after exposure (slope: –0.100 vs –0.059 for post-exposure vs pre-exposure, respectively; difference: –0.041; 95% confidence interval: –0.074, –0.008; P=0.016). Cognitive impairment could be attributed to declines in memory and attention/executive cognitive domains.In older adults, exposure to general anaesthesia and surgery was associated with a subtle decline in cognitive z-scores. For an individual with no prior exposure and with exposure after enrolment, the decline in cognitive function over a 5 yr period after the exposure would be 0.2 standard deviations more than the expected decline as a result of ageing. This small cognitive decline could be meaningful for individuals with already low baseline cognition.