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]: 47e60) had improved cognitive test scores, whereas 26 (12%, 95% CI: 7.6e16)showed cognitive decline at 3 months postoperatively. In patients aged >75 years, the incidenceof overall cognitive decline 3 months postoperatively was 18% (95% CI: 9.3e27). Inpatients with lower pre-operative MinieMental State Examination (MMSE) score (26)the incidence was 37% (95% CI: 18e57), and in patients undergoing major surgery it was18% (95% CI: 10.6e26). Of the cognitive domains, executive function was the most vulnerableto 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.

Original languageEnglish
Pages (from-to)394-402
Number of pages9
JournalEuropean Journal of Cancer
Volume86
DOIs
Publication statusPublished - Nov-2017

Keywords

  • Age Factors
  • Aged
  • Aging
  • Cognition
  • Cognitive Dysfunction
  • Executive Function
  • Female
  • Humans
  • Male
  • Memory
  • Mental Status and Dementia Tests
  • Neoplasms
  • Netherlands
  • Prospective Studies
  • Risk Factors
  • Surgical Procedures, Operative
  • Time Factors
  • Trail Making Test
  • Treatment Outcome
  • Journal Article
  • Observational Study

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