Mesane kanseri hastalarında sarkopeni ve postoperatif kognitif fonksiyon bozukluğu ilişkisi

Yıl 2020, , 754 - 756, 01.09.2020

Semih Kalyon , Perihan Özkan Gümüşkaya Neslihan Özsoy Mustafa Özcan Şengül Aydın Yoldemir , İlkim Toprak , Özgür Altun Murat Akarsu , Eylem Özgün Çil Yücel Arman , Tufan Tükek

https://doi.org/10.28982/josam.774124

Öz

Amaç: Sarkopeninin 65 yaş üzeri genel anestezi almış hastalarda ameliyat sonrası erken dönemde kognitif fonksiyonlar üzerine olumsuz etkisinin olup olmadığını gösterir çalışma literatürde yoktur. Postoperatif erken dönemde trans ürektal mesane kanseri rezeksiyonu olmuş yaşlı hasta popülasyonunda sarkopeni ve kognitif fonksiyon bozukluğu ilişkisini saptamak bu çalışmanın amacıdır.
Yöntemler: Trans uretral mesane rezeksiyonu operasyonu geçirecek olan 65 yaş üzeri hasta popülasyonunda; operasyon öncesi ve operasyondan 24 saat sonra erken dönemde minimental test yapılarak kognitif fonksiyonlar tek merkezli kesitsel bu çalışmada değerlendirildi. Tüm hastalara operasyon öncesi yürüme testi yapıldı ve kas kitlesi, kg/m² cinsinden biyoimpedans terazi ile ölçüldü. Yürüme testinde hızı >0,8 m/sn olan hastaların kas gücü ise, el sıkma dinamometresi ile ölçüldü. Düşük yürüme hızı ve kas kütlesi, normal yürüme hızı ancak düşük kavrama gücü ve kas kütlesi sarkopeni kriterleri olarak kabul edildi.
Bulgular: Postoperatif erken dönemde, çalışmaya alınan 43’ü erkek 54 kişilik tüm geriatrik hasta popülasyonunda kognitif fonksiyonlarda azalma saptandı. Hem sarkopenik hem de sarkopenik olmayan grupta ortalama yaş 74 idi. 15 kişilik Sarkopenik hasta grubunda postoperatif erken dönemde kognitif fonksiyon bozukluğu 39 kişilik sarkopenik olmayan gruba göre daha fazlaydı (sırasıyla P=0,001, P=0,026). Ancak Sarkopenik hastalardaki kognitif fonksiyondaki bu azalma Sarkopenik olmayan hastalara göre istatistiksel olarak anlamlı değildi (P=0,644).
Sonuç: Biz bu çalışmada anestezi sonrası erken ameliyat sonrası dönemde kognitif fonksiyonların tüm geriatrik hasta popülasyonunda azaldığını gösterdik. Sarkopenik hasta grubunda postoperatif kognitif fonksiyonlardaki azalma istatistiksel olarak anlamlı olmasa da Sarkopenik olmayanlara göre daha fazladır. Dolayısıyla, istatistiksel olarak anlamlı farkı yakalayacak daha çok hasta sayılı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Sarkopeni, Geriatri, Gerontoloji, Kognisyon

The relationship between sarcopenia and cognitive dysfunction in bladder tumor patients

Öz

Aim: There is no study in the literature to show whether there is a negative effect of sarcopenia on cognitive functions in patients over 65 years of age in the early postoperative period, who were operated under general anesthesia. The aim of this study was to determine the relationship between sarcopenia and cognitive dysfunction in the early postoperative period of transurethral resection of bladder tumor operation in the elderly population with bladder cancer.
Methods: The cognitive functions of patients over the age of 65 years who underwent transurethral resection of bladder tumor were evaluated before and 24 hours after the surgery with mini-mental tests in this single center, cross sectional study. All patients underwent a preoperative gait test and muscle mass was measured. The muscle strength of the patients with walking speed >0.8 m / sec in the walking test was measured by hand grip dynamometer. Low walking speed and muscle mass, and normal walking speed, but with low handgrip power and muscle mass were the accepted criteria of Sarcopenia.
Results: In the early postoperative period, a decrease in cognitive functions was observed in the population of 54 geriatric patients, 43 of whom were male. The mean age was 74 years in both sarcopenic and non-sarcopenic groups. Cognitive dysfunction was more common in the sarcopenic patient group of 15 patients in the early postoperative period compared to the non-sarcopenic group of 39 patients (P=0.001, P=0.026 respectively). However, this decrease in cognitive function in sarcopenic patients was not statistically significant compared to non-sarcopenic patients (P=0.644).
Conclusion: We demonstrated that cognitive functions decreased in early postoperative period in the geriatric patient population. The decrease in postoperative cognitive functions in sarcopenic patients was higher than that in non-sarcopenic patients, although the difference was not statistically significant. Therefore, larger studies with more patients are needed to achieve a statistically significant difference.

Anahtar Kelimeler

Sarcopenia, Geriatrics, Gerontology, Cognition

Kaynakça

• 1. Chang KV, Hsu TH, Wu WT, Huang KC, Han DS. Association Between Sarcopenia and Cognitive Impairment: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc. 2016 Dec 1;17(12):1164.e7-1164.e15. doi: 10.1016/j.jamda.2016.09.013. Epub 2016 Nov 2.
• 2. Buch A, Carmeli E, Boker LK, Marcus Y, Shefer G, Kıs O, et al. Muscle function and fat content in relation to sarcopenia, obesity and frailty of old age. An overview. Exp Gerontol. 2016;76:25e32.
• 3. Han DS, Chang KV, Li CM, Lin YH, Kao TW, Tsai KS, et al. Skeletal muscle mass adjusted by height correlated better with muscular functions than that adjusted by body weight in defining sarcopenia. Sci Rep. 2016;6:19457.
• 4. Pagotto V, Silveira EA. Methods, diagnostic criteria, cutoff points, and prevalence of sarcopenia among older people. Sci World J. 2014;2014:231312.
• 5. Budui SL, Rossi AP, Zamboni M. The pathogenetic bases of sarcopenia. Clin Cases Miner Bone Metab. 2015;12:22e26.
• 6. Yanai H. Nutrition for sarcopenia. J Clin Med Res. 2015;7:926e931.
• 7. Peterson SJ, Braunschweig CA. Prevalence of sarcopenia and associated outcomes in the clinical setting. Nutr Clin Pract. 2016;31:40e48.8
• 8. Cabett Cipolli G, Sanches Yassuda M, Aprahamian I. Sarcopenia Is Associated with Cognitive Impairment in Older Adults: A Systematic Review and Meta-Analysis. J Nutr Health Aging. 2019;23(6):525-31. doi: 10.1007/s12603-019-1188-8.
• 9. Tolea MI, Galvin JE. Sarcopenia and impairment in cognitive and physical performance. Clin Interv Aging. 2015 Mar 30;10:663-71. doi: 10.2147/CIA.S76275. eCollection 2015.
• 10. Landi F, Cruz-Jentoft AJ, Liperoti R, Russo A, Giovannini S, Tosato M, et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: Results from ilSIRENTE study. Age Ageing. 2013;42:203e209.
• 11. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults. J Gerontol Ser A Biol Sci Med Sci. 2001;56:146e157.
• 12. Landi F, Cesari M, Calvani R, Cherubini A, Di Bari M, Bejuit R, et al. The "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) randomized controlled trial. Aging Clin Exp Res. 2017 Feb;29(1):89-100. doi: 10.1007/s40520-016-0715-2. Epub 2017 Jan 31.
• 13. Chen K, Wei P, Zheng Q, Zhou J, Li J. Neuroprotective effects of intravenous lidocaine on early postoperative cognitive dysfunction in elderly patients following spine surgery. Med Sci Monit. 2015 May 15;21:1402-7. doi: 10.12659/MSM.894384.
• 14. Shan X, Zhang X, Li X, Xu G, Li Z. Effect of ulinastatin on postoperative cognitive function in the elderly with fracture. Zhonghua Yi Xue Za Zhi. 2015 May 26;95(20):1586-9.