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.
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.
Keywords
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Article info
Publication history
Published online: November 01, 2017
Accepted:
September 18,
2017
Received in revised form:
September 17,
2017
Received:
July 21,
2017
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
