Cognitive decline after major oncological surgery in the elderly

• Published in: European journal of cancer (1990) Vol. 86; pp. 394 - 402
• Main 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.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.11.2017; Elsevier Science Ltd
• Subjects: Age Factors; Aged; Aging - psychology; Cancer surgery; Cognition; Cognition & reasoning; Cognitive ability; Cognitive decline; Cognitive Dysfunction - diagnosis; Cognitive Dysfunction - etiology; Cognitive Dysfunction - psychology; Cognitive tasks; Confidence intervals; Decision making; Elderly; Executive Function; Female; Geriatrics; Health risks; Humans; Incidence; Male; Memory; Mental Status and Dementia Tests; Neoplasms - surgery; Netherlands; Older people; Oncology; Patients; Postoperative period; Prospective Studies; Quality of life; Risk analysis; Risk Factors; Solid tumors; Surgery; Surgical oncology; Surgical Procedures, Operative - adverse effects; Time Factors; Trail Making Test; Treatment Outcome; Cognitive decline; Elderly; Surgical oncology
• ISSN: 0959-8049; 1879-0852; 1879-0852
• DOI: 10.1016/j.ejca.2017.09.024

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. 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. 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. 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. •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.