Heeres, A. (2014) De Groningen Frailty Indicator (GFI) en de Charlson Comorbidity Index in relatie tot postoperatieve cognitieve disfunctie (POCD) bij oudere kanker patiënten. Sub-studie van ‘Postoperative cognitive dysfunction in elderly cancer patients: PICNIC-study’. thesis, Medicine.
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Abstract
Background: Because of the global growth of the elderly population, the incidence of elderly cancer patients increases. Thereby, the number of oncological-surgeries for elderly patients who undergo surgery for cancer increases as well. A common complication in this group of patients is postoperative cognitive detoriation. Up till now, the underlying mechanisms and causative factors of this cognitive change remain unclear. Also it is unknown if comorbidity or preoperative frailty influences the incidence of this complication, although both features are common within this category of patients. We aimed to determine the effect of these on the course of postoperative cognitive function in elderly oncological-surgery patients. Objective: To examine the association between preoperative frailty and comorbidity with postoperative cognitive dysfunction within elderly cancer patients. Methods: In total we enrolled 87 patients of 65 years or older. All of them were patients of the departments of surgical oncology or gynecology departments in the University Medical Center Groningen. They were scheduled for surgery for a solid malignant tumor and fully completed the cognitive testing batteries before and after surgery. Cognitive functioning was assessed preoperatively, 3 months and 1 year postoperatively. We used four neuropsychological tests, containing the Minimal Mental State Examination (MMSE), Rey’s Verbal Learning Test (RVLT), Trailmaking Test (TMT) and the Ruff’s Figural Fluency Test (RFFT). Comorbidity was assessed with the Charlson Comorbidity Index (CCI) and frailty with the Groningen Frailty Indicator (GFI). The individual postoperative test scores were compared with the preoperatively test scores. By using composite scores the cognitive function was studied based on comorbidity and frailty. Possible independent predictors of postoperative cognitive decline were analyzed by using multiple linear regression analysis. Results: The 3 months postoperative test results improved significantly compared to preoperatively. The 12 months postoperative test results were significantly better than the preoperative tests as well; but compared to the test results of 3 months postoperatively they were not even more improved. The group with higher comorbidity tested significantly more worse during all testing moments (respectively p=0.009, p=0.003, p=0.003). Further, the low comorbidity group showed cognitive improvement at 3 months postoperatively, compared to preoperative test scores. (p=<0.001) Differences in frailty did not give significant changes in cognitive functioning. Age, education level and comorbidity turned out as independent predictors for postoperative cognitive decline. Age and comorbidity turned out as independent predictors at 12 months postoperatively. Age was the strongest predictor. Conclusion: The postoperative cognitive function improved. The postoperative test results improved significantly both at 3 months and 12 months. Patients with higher comorbidity did achieve significant worse during al testing moments compared to the low comorbidity group. Differences in frailty did not affect the cognitive function. Age, education level and comorbidity were independent predictors for the development of postoperative cognitive decline.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Izaks, dr. G.J. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:56 |
| Last Modified: | 25 Jun 2020 10:56 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1688 |
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