Nine-hundred and fifty patients with hip fracture were randomised to general anaesthesia (n=474) or regional anaesthesia without sedation (n=476); the 12-month cognitive follow-up analysis included two-hundred and ninety-three patients (general n=139; regional n=154). The primary outcome was 12-month postoperative cognitive decline (MMSE-based Z-score approach versus population controls). Secondary outcomes included severity of decline (major/mild), MMSE change from baseline, incident dementia, affective status (HADS), and health-related quality of life (SF-36). Outcomes were assessed pre-operatively, at 7 days, and up to 12 months. Overall, the results of the study revealed no difference in 12-month cognitive decline between groups, with similar rates of major decline (8.6% vs 8.5%) and comparable MMSE trajectories, dementia, HADS, and SF-36 scores. In short, the choice of regional versus general anaesthesia did not alter 1-year cognitive outcomes after hip-fracture surgery.