Norel, A. van (Annemarie) (2013) Postoperatieve cognitieve dysfunctie bij oudere chirurgisch-oncologische patiënten: vergelijking van cognitie met de algemene bevolking. thesis, Medicine.
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Abstract
Aim: The aim of this study is to investigate the course of neurocognitive scores between patients who will and who will not undergo surgery. Background: Ageing involves an increase in diseases, but also a decline in the cognitive capacity. An accelerated, but mostly transient, decline can develop after surgery. This is called postoperative cognitive dysfunction (POCD). Until now, there have been many studies to discover causal and predictive factors of POCD. However, the knowledge about POCD is scarce. The diagnose is made on neurocognitive testing, but there has not been research to discrepancies between patients who undergo surgery and the general population. After all, ageing itself causes decline. On the other hand a test-retesteffect can exist with repetitive testing. Methods: This prospective observational study, called the PICNIC-study, includes oncology patients with the age of 65 and older who need surgery. Three neurocognitive tests, the RAVLT, TMT and RFFT, were taken on four moments, including preoperative, postoperative, after three months and after one year. 125 patients have completed the study. A variety of patient specific and surgery specific factors have been noted. Besides, the reference data are collected by literature research, selecting the articles to test and other criteria. Results: The course of the PICNIC-cohort differed from the reference cohorts. Firstly, the RAVLT-scores in the PICNIC-cohort were statistic significantly lower preoperatively (p = 0.001). In contrast, postoperatively the executive functions showed different results. A slight, although not statistic significant, decline was found in TMT-A and TMT-B postoperatively (p = 0.93; p = 0.17). The executive function RFFT showed in the PICNIC-cohort an increase in unique patterns (p = 0.02), but the total of perseverative errors did not decrease as the reference group showed (p = 0.94). Patients with a postoperative delirium showed a decline in all tests. Besides, the individual test results were influenced by a number of variables, such as gender, age and educational level. Conclusions: Surgery has a negative influence on the cognition of the older patient. Compared with the general population patients who underwent surgery showed a decrease in executive function. The time to complete TMT increased and the perseverative errors for the RFFT remained the same. The cognitive domain memory showed no decrease. Patients who underwent surgery remembered more words with the RAVLT, except patients who developed a postoperative delirium.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Izaks, dr. G.J. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:57 |
| Last Modified: | 25 Jun 2020 10:57 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1763 |
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