Influence and Impact of Cognitive Trajectories on Outcome in Patients Undergoing Radical Cystectomy: An Observational Study

Abstract

Objectives: To evaluate cognitive trajectories after radical cystectomy and their impact on surgical outcomes, including urinary continence. Results: Mean age was 67.9 ± 9.3 years (range 40 -88 years). Sixty-six patients (73.3%) had stable cognition, nine patients (10.0%) persistent and seven patients (7.8%) transient deterioration, five patients (5.6%) persistent and three patients (3.3%) transient improvement. An impaired preoperative cognition was the only significant risk factor of short-term cognitive deterioration (OR adjusted for age and sex 9.4, 95%CI 1.6-56.5, p=0.014). Cognition showed no associations with 1-year mortality, 90-day complication rate, cancer progression or duration of in-hospital stay. Patients with transient or persistent cognitive deterioration had an increased risk for nighttime incontinence (OR adjusted for age and sex 5.1, 95%CI 1.1-22.4, p=0.032). Methods Conclusions:In this study, the majority of patients showed stable cognition after major abdominopelvic surgery. Cognitive deterioration occurred in a small subgroup of patients, and an impaired preoperative cognition was the only significant risk factor.Postoperative cognitive deterioration was associated with nighttime incontinence.3

Cognitive function in patients undergoing cystectomy for bladder cancer – results from a prospective observational study

“…The majority of patients presented a postoperative stable MMSE outcome, although pre-existing deficits were found to be the greatest risk factor for postoperative deterioration. 23 Similarly, a study from 2013 already showed that preoperatively lower MMSE scores were associated with a higher probability of developing postoperative delirium and the need for surgical revision in patients undergoing RC, although no assumptions on MCI prevalence can be drawn from this trial. 24 …”

“…The majority of patients presented a postoperative stable MMSE outcome, although pre-existing deficits were found to be the greatest risk factor for postoperative deterioration. 23 Similarly, a study from 2013 already showed that preoperatively lower MMSE scores were associated with a higher probability of developing postoperative delirium and the need for surgical revision in patients undergoing RC, although no assumptions on MCI prevalence can be drawn from this trial. 24 Besides determining the prevalence of MCI in patients with MIBC before RC and identifying possible risk factors, the aims of this study included comparison of DemTect, MMST, and clock drawing test results as well as differentiation of MCI from anxiety and depression and to examine the relationship between MCI and perioperative complication rates.…”

Choosing between Orthotopic Neobladder and Ileal Conduit after Radical Cystectomy: Tools for Assessing Patient-Specific Characteristics and Enhancing the Decision-Making Process—A Review of Current Studies

“…Assessment of cognitive impairment (CI), frailty, dexterity, or factors related to patient preferences are recommended [ 9 ], however, correlation of these factors is usually evaluated with postoperative outcomes, not upon qualification for UD [ 10 , 11 , 12 ].…”