Inflammation and the development of postoperative cognitive problems in elderly cancer patients.

Bongaerts, T.H.G. (2013) Inflammation and the development of postoperative cognitive problems in elderly cancer patients. thesis, Medicine.

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Abstract

Introduction: Postoperative cognitive dysfunction (POCD) is a major complication after surgery, this can occur shortly after surgery, but also persist long-term. Especially older people are more prone to develop POCD. In clinical practice this condition is often under diagnosed and often no distinction is made between POCD and a postoperative delirium (a state of either hyperactive, hypoactive or mixed type; DSM IV). This leads to suboptimal treatment. The pathophysiology of especially POCD remains unclear. The general idea is that it is a multifactorial process, which can be triggered by many different origins. Surgery causes an inflammatory reaction through the release of various inflammatory mediators, e.g. serum Interleukin-6 (IL-6). This cytokine can enter the brain directly through active transport mechanisms or indirectly through vagal nerve stimulation. One of the most recent ideas is that a systemic inflammatory response induced by surgery, hence the rise of serum IL-6, causes the development of neuro-inflammation, resulting in POCD. The purpose of this study was to examine whether a systemic inflammatory response i.e. a rise in serum IL-6, CRP and leukocytes, is related to the incidence of cognitive postoperative problems, i.e. POCD and delirium, in elderly surgical cancer patients. Methods: One hundred twenty-five patients undergoing elective surgery for a solid malignant tumor, aged 65 years and older, were included in this observational prospective study. POCD was defined as a decline of 15% or more at the Ruff Figural Fluency Test and the Trailmaking Test (TMT)-A and/ or -B. Data concerning postoperative delirium diagnosis (DSM IV) were collected. Before and after closing the surgical wound, a blood sample was obtained. Of 41 patients serum IL-6 (pg/ml) was determined using ELISA. CRP (mg/l) and leukocytes (109/l) were determined during day 1 and 7 days postoperatively; this was done of 13 patients. Results: Of 96 patients postoperative, and 93 three months postoperatively, cognitive status was determined. Most people were lost to follow up due to the burden the study entails. Two weeks postoperatively 18 patients (18,75%) were found to suffer from POCD. Three months after surgery 16 patients did (17,20%). Twelve patients were diagnosed with a postoperative delirium (10,71%). To examine the development of inflammatory processes four groups were compared: patients with POCD (n=11), delirious patients (n=7), patients suffering of both (a combined group, n=2) and patients without any form of cognitive decline (n=21). Delirium patients showed significant higher postoperative serum IL-6 levels (p = .03). The increase of serum IL-6 in POCD patients was not found to be significant (p = .08). Also postoperative CRP levels tend to be higher in delirium patients, and showed an increase over a one-week timespan. POCD patients and the control group showed a seeming decrease of CRP-levels over time. The amount and increase of leukocytes did not seem to differ between subgroups. Data of CRP and leukocytes were too limited to test for statistical significance. Conclusion: First results suggest that inflammatory processes are related to the development of a postoperative delirium, but not to the existence and development of POCD. However, since subgroups are small and show a wide variation more research is needed. This may lead to the development of preventive interventions.

Item Type:	Thesis (Thesis)
Supervisor name:	Leeuwen, dr. B.L. van
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:46
Last Modified:	25 Jun 2020 10:46
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/789

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