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ID
Source
Brief title
Health condition
Diabetes; impaired glucose tolerance; frailty; neurocognitive dysfunction; postoperative cognitive dysfunction
Sponsors and support
Intervention
Outcome measures
Primary outcome
- Changes in scores for the TICS questionnaire administered preoperative vs. 1 month, 3 and 12 months postoperative
Secondary outcome
- Correlation of preoperative metabolic impairment and postoperative neurocognitive outcome
- Changes in scores for the WHODAS 2.0 questionnaire administered preoperative vs. 6 months postoperative
- Correlation between the G8 frail scale score preoperative and postoperative neurocognitive outcome
- Correlation between demographics (age & gender) and postoperative neurocognitive outcome
- Correlation between BMI and postoperative neurocognitive outcome
- Correlation between medical history and postoperative neurocognitive outcome
- Correlation between medication use and postoperative neurocognitive outcome
Background summary
Postoperative cognitive dysfunction (POCD) occurs relatively frequently after surgery. POCD has been shown to increase the risk of subsequent dementia as well as premature death. However, because of poor characterization of the syndrome and resulting lack of diagnostic criteria, substantial variation exists in reported incidence rates.
Evidence is growing that impaired glucose metabolism and diabetes mellitus are associated with POCD, though the pathophysiology remains largely unknown. Possible mechanisms include autonomic neuropathy, hyperglycaemia induced neurotoxic changes, temporary states of hypoglycemia caused by antihyperglycemic treatment and pre-existing vascular damage.
The primary question is whether patients with impaired glucose metabolism or diabetes mellitus who get POCD have preexisting cognitive dysfunction, or if this results from the procedure.
We hypothesize that POCD depends largely on preoperative cognitive dysfunction and frailty, rather than metabolic impairment alone.
Clarifying the potential role of diabetes, glycemic levels and a history of hypoglycemia is important to be able to provide reliable risk assessment prior to surgery, to tailor post‐surgery clinical care and to inform hypotheses on the mechanisms leading up to POCD. To answer our research question, we aim to perform a prospective cohort study in patients >65 years old undergoing elective surgery.
Study objective
We hypothesize that POCD depends largely on preoperative cognitive dysfunction and frailty, rather than metabolic impairment alone.
Study design
Preoperative: TICS-M and WHODAS 2.0 questionnaire, G8 frail scale, blood tests (incl. HbA1c, Na, K, creatinine)
One month postoperative: TICS-M questionnaire and WHODAS 2.0 questionnaire
Six months postoperative: TICS-M questionnaire and WHODAS 2.0 questionnaire
Intervention
N/A
Inclusion criteria
All patients ≥65 years old that visit the preoperative screening at the anesthesia outpatient clinic.
Exclusion criteria
Patients ≥65 years old who do not wish to participate in cognitive screening.
Design
Recruitment
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In other registers
| Register | ID |
|---|---|
| NTR-new | NL7530 |
| Other | METC Amsterdam UMC, location AMC : W19_044 # 19.067 |