Cognitive decline after major oncological surgery in the elderly. (November 2017)

• Record Type: Journal Article
• Authors: Plas, M.; Rotteveel, E.; Izaks, G.J.; Spikman, J.M.; van der Wal-Huisman, H.; van Etten, B.; Absalom, A.R.; Mourits, M.J.E.; de Bock, G.H.; van Leeuwen, B.L.
• Is Part Of: European journal of cancer. Volume 86(2017)
• Page Start: 394
• Page End: 402
• Publication Date: 2017-11
• Subjects: Cognitive decline -- Surgical oncology -- Elderly; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2017.09.024
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: Elderly patients undergoing oncological surgery experience postoperative cognitive decline. The aims of this study were to examine the incidence of cognitive decline 3 months after surgery and identify potential patient-, disease- and surgery-related risk factors for postoperative cognitive decline in onco-geriatric patients. Methods: A consecutive series of elderly patients (≥65 years) undergoing surgery for the removal of a solid tumour were included (n = 307). Cognitive performance was assessed pre-operatively and 3 months postoperatively. Postoperative decline was defined as a decline in scores of cognitive tests of ≥25% on ≥2 of 5 tests. Results: Of the patients who had completed the assessments, 117 (53%, 95% confidence interval [CI]: 47–60) had improved cognitive test scores, whereas 26 (12%, 95% CI: 7.6–16) showed cognitive decline at 3 months postoperatively. In patients aged >75 years, the incidence of overall cognitive decline 3 months postoperatively was 18% (95% CI: 9.3–27). In patients with lower pre-operative Mini–Mental State Examination (MMSE) score (≤26) the incidence was 37% (95% CI: 18–57), and in patients undergoing major surgery it was 18% (95% CI: 10.6–26). Of the cognitive domains, executive function was the most vulnerable to decline. Conclusion: About half of the elderly patients show improvement in postoperative cognitive performance after oncological surgery, whereas 12% show cognitive decline. Advanced age, lower pre-operative MMSE score and major surgery are risk factors for cognitive decline at 3 months postoperatively and should be taken into account in the clinical decision-making progress. Research to develop interventions to preserve quality of life should focus on this high-risk subpopulation. Highlights: In the elderly oncological patients, postoperative cognitive decline occurs in up to 12%. Advanced age, major surgery and lower pre-operative Mini–Mental State Examination score are risk factors. Of the cognitive domains, executive function is the most vulnerable to decline.