The link between the early surgery‐induced inflammatory response and postoperative cognitive dysfunction in older patients

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 72; no. 5; pp. 1360 - 1372
• Main Authors: Brattinga, Baukje, Plas, Matthijs, Spikman, Jacoba M., Rutgers, Abraham, Haan, Jacco J., Wal‐Huisman, Hanneke, Absalom, Anthony R., Nieuwenhuijs‐Moeke, Gertrude J., Munster, Barbara C., Bock, Geertruida H., Leeuwen, Barbara L.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.05.2024; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Biomarkers - blood; C-Reactive Protein - analysis; Cancer; Cognitive ability; cognitive decline; Executive function; Female; Gelatinase; Humans; Inflammation; Inflammation - blood; Information processing; Leukocytes (neutrophilic); Lipocalin; Lipocalin-2 - blood; Male; Mental Status and Dementia Tests; Neoplasms - surgery; Older people; Plasma levels; Postoperative Cognitive Complications - blood; Postoperative Cognitive Complications - epidemiology; Postoperative Cognitive Complications - etiology; Postoperative Complications - blood; Postoperative Complications - etiology; postoperative neurocognitive disorder; Postoperative period; Prospective Studies; Quality of life; Regression analysis; Solid tumors; Surgery; cancer; postoperative neurocognitive disorder; cognitive decline; inflammation
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.18876

Background Postoperative cognitive dysfunction (POCD) is a common complication in older patients with cancer and is associated with decreased quality of life and increased disability and mortality rates. Systemic inflammation resulting in neuroinflammation is considered important in the pathogenesis of POCD. The aim of this study was to explore the association between the early surgery‐induced inflammatory response and POCD within 3 months after surgery in older cancer patients. Methods Patients ≥65 years in need of surgery for a solid tumor were included in a prospective cohort study. Plasma levels of C‐reactive protein (CRP), interleukin‐1 beta (IL‐1β), IL‐6, IL‐10, and Neutrophil gelatinase‐associated lipocalin (NGAL) were measured perioperatively. Cognitive performance was assessed preoperatively and 3 months after surgery. POCD was defined as a decline in cognitive test scores of ≥25% on ≥2 of five tests within the different cognitive domains of memory, executive functioning, and information processing speed. Logistic regression analysis was performed. Results POCD was observed in 44 (17.7%) of 248 included patients. Age >75, preoperative Mini‐Mental State Examination (MMSE) score ≤26 and major surgery were independent significant predictors for POCD. In multivariate logistic regression analysis, no significant associations were shown between the early surgery‐induced inflammatory response and either POCD or decline within the different cognitive domains. Conclusions This study shows that one out of six older patients with cancer developed POCD within 3 months after surgery. The early surgery‐induced inflammatory response was neither associated with POCD, nor with decline in the separate cognitive domains. Further research is necessary for better understanding of the complex etiology of POCD.