Is a postoperative delirium associated with postoperative cognitive dysfunction?

Karsch, S. (Saskia) (2014) Is a postoperative delirium associated with postoperative cognitive dysfunction? thesis, Medicine.

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Abstract

Background: Global growth of the elderly population, and therefore increasing incidence of cancer, leads to an increase in surgery as the treatment of solid malignant tumor often consist of surgery. Following surgery, patients may experience cognitive decline. Delirium is common after surgery in elderly patients and may be associated with long-term changes in cognition. Postoperative cognitive dysfunction (POCD) is mainly seen in the elderly and is thought to be mediated by surgery induced inflammatory reactions. However, the underlying mechanism of this postoperative cognitive change remains unclear. Postoperative delirium and cognitive dysfunction (POCD) are topics of special importance in the geriatric surgical population. They are two main entities of postoperative cognitive decline, whose relationship has yet to be further explored to be fully understood. We hypothesized that experiencing a postoperative delirium would be associated to the development of postoperative cognitive dysfunction. Further, other possible risk factors on the development of POCD were tried to determine. Methods: 177 cancer patients of 65 years old or older performed preoperative cognitive tests containing the Trailmaking test (TMT) and Ruff’s figural fluency test (RFFT). At 3 months follow up the same cognitive tests were assessed. 106 patients also completed the 12 month follow up test, containing only the Trailmaking Test. Perioperative data such as the type and goal of surgery and the type and duration of anesthesia were collected. At time of admission the Groningen Frailty indicator (GFI) and the Charlson comorbidity score were administered. The DOS score was filled out until 7 days after surgery to collect data regarding delirium. We identified POCD by the difference between the preoperative scores and the scores on the follow up tests. When there was an increase in time to finish the trailmaking test or a decline in the sum of unique patterns drawn on the Ruff’s figural fluency test at the 3 months follow up tests it was defined as short term POCD.A decline in unique patterns drawn at the 12 months follow up test was defined as long term POCD. Possible associations were analyzed by using univariate and multivariate logistic regressions. Results: Short term postoperative cognitive dysfunction was present in 103(58.1%) patients and long term postoperative cognitive dysfunction was present in 57(61.9%) patients. We found a relationship between a postoperative delirium and short term POCD(p=0.018). In 14 (20.5%)patients we found short term POCD after experiencing a postoperative delirium compared to 54 (79.5%) patients with short term POCD but without experiencing a postoperative delirium. A postoperative delirium was not a significant risk factor for long term POCD. Age between 85-90 years old was a risk factor for short term POCD(p=0.036).Gender is associated with the presence of long term POCD(p=0.022). Conclusion: Short term postoperative cognitive dysfunction is associated with a postoperative delirium in contrast to long term postoperative cognitive dysfunction were no association is found. Other than age for short term POCD and gender for long term POCD no risk factors were identified.

Item Type:	Thesis (Thesis)
Supervisor name:	Leeuwen, Dr. B.L van
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:59
Last Modified:	25 Jun 2020 10:59
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1926

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