Til, N.E. van (2014) Nutritional status and Body Mass Index in relation to postoperative cognitive dysfunction (POCD) in elderly cancer patients. thesis, Medicine.
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Abstract
Background: Cancer is a disease of the elderly. With an increase in the ageing population, the prevalence of cancer increases. The treatment of a solid malignant tumor often consists of surgery. Elderly patients are not only prone to physical complications due to age and co morbidity, but also psychological complications can occur, one of them being postoperative cognitive dysfunction (POCD). In part of the elderly surgical patients a decline in cognitive functioning can occur. The incidence of POCD and its causative and underlying mechanisms remain unknown. Previous studies have postulated an effect of BMI and/or nutritional status on cognitive performance; however no study has been performed to investigate the effect on cognitive decline after surgery. In this study we included elderly patients who needed surgery for cancer, either non-gynecological as well as gynecological patients. We will compare the gynecological and non-gynecological patients in relation to POCD, to investigate whether there are differences between these groups. Objectives: To examine whether BMI, serum albumin and weight loss prior to surgery as a measure for nutritional status are related to the incidence of short-term POCD (3 months postoperatively) and long-term POCD (1 year postoperatively) in elderly gynecological and non-gynecological patients. Methods: We enrolled 51 gynecological patients and 204 non-gynecological patients aged 65 years or older from the department of Gynecologic Oncology and the department of Surgery of the University Medical Center Groningen, who are scheduled for a surgical treatment for a solid malignant tumor. Cognitive functioning was assessed preoperatively, 3 months and 1 year postoperatively by using the Ruff Figural Fluency Test and the Trail Making Test part A and B. Nutritional status was assessed by asking patients whether they had lost weight of 6 or more kilograms in the 6 months prior to surgery; BMI and serum albumin were measured one day preoperatively. We identified POCD by comparing the individual change in postoperative test scores with the mean change in test scores of all patients. POCD was then defined as a change in test score of at least 1 SD below the mean change in scores and subdivided in short- and long-term POCD. Results: In total 173 (67.8%) patients completed the preoperative and 3 months postoperative test sessions; 38 (22.0%) of them were diagnosed with short-term POCD. 94 (36.9%) patients completed the preoperative and 1 year postoperative test sessions of which 10 (10.6%) have been diagnosed with long-term POCD. No differences were found between the gynecological and non-gynecological patients for the incidences, BMI, weight loss and serum albumin, so analyses have been performed on the two patient groups combined. Higher BMI was shown to have a protective association with short-term POCD (OR=0.895, p=0.036); time needed to complete preoperative TMT-B is negatively associated with short-term POCD (OR=1.007, p=0.009). Age was found to be a predictor for short-term POCD, but when adjusted for preoperative TMT-B score it did not remain statistically significant. Weight loss and serum albumin were not associated with either short- or long-term POCD. Conclusion: A higher BMI is associated with a decrease in POCD risk whereas an increase in time needed to complete preoperative TMT-B leads to an increased risk on developing short-term POCD. Age remained no predictor for short-term POCD when adjusted for preoperative TMT-B score. There was an improvement of the postoperative test scores compared to the preoperative tests scores. Serum albumin and weight loss were not associated with the risk on developing short- or long-term POCD. No predictors have been found for long-term POCD. Also, we found no differences between the gynecological and non-gynecological patient groups. Further research needs to be done to clarify the underlying mechanism of BMI and nutritional status and its effect on the development of POCD.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Leeuwen, dr. B.L. van and Mourits, prof. dr. M.J.E. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:40 |
| Last Modified: | 25 Jun 2020 10:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/210 |
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