The effect of type 2 diabetes mellitus on early postoperative cognitive functions

Yıl 2022, , 552 - 556, 01.05.2022

Seda Seven , İlkay Ceylan , Durmuş Kaymak Ali Giray Kara , Veysel Erden

https://doi.org/10.28982/josam.947765

Öz

Background/Aim: Postoperative cognitive dysfunction (POCD) is an important problem that is encountered perioperatively and has a complex pathophysiology. Diabetes mellitus (DM) can cause adverse effects on cognitive functions, such as memory dysfunctions, psychomotor retardation, slower information processing, impairment of complex motor functions, deterioration of verbal rationality, and attention deficit. We assume that DM will have a triggering effect on POCD. Mild cognitive dysfunction caused by diabetes mellitus may increase the risk of POCD. For this purpose, we aimed to investigate the effect of type 2 DM on early POCD.
Methods: Fifty literate patients who ranked 1-2 on the American Society of Anesthesiologists (ASA) scale were included in our prospective case-control study. They ranged in age from 35 to 70. All were scheduled for elective laparoscopic cholecystectomy at the İstanbul Training and Research Hospital. Patients were divided into two groups: the diabetes mellitus group and the control group. The DM group consisted of 25 patients who had been diagnosed with type 2 DM and had been on regular oral antidiabetic medication or insulin for at least five years. To examine the patients neuropsychologically, the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) Test were conducted one day before the surgery. The MMSE and MoCA were repeated at the 4th and 24th hours postoperatively. The patients were monitored to record their depth of anesthesia, peak heart rate, mean arterial pressure, oxygen saturation, end-tidal carbon dioxide value, and expiratory sevoflurane concentration prior to perioperative intubation and every five minutes after intubation until the end of the operation. The state of postoperative pain and total analgesic dose used for the patients were also recorded.
Results: Demographic data in both groups were similar in terms of age, gender, body mass index, and duration of surgery (P > 0.05 for each). Perioperative depth of anesthesia, hemodynamic data, and postoperative pain scores were similar in both groups (P > 0.05 for each). While there was initially no significant difference between the groups in terms of preoperative cognitive function, compared with the control group, the DM group had significantly lower values of MMSE and MoCA at the postoperative 4th (P = 0.014 and P = 0.014) and 24th hour (P = 0.026 and P = 0.01) .
Conclusion: Our study shows that the early postoperative cognitive functions of diabetic patients are affected more than non-diabetic patients in laparoscopic surgery. MMSE and MoCA tests are appropriate for screening type 2 diabetic patients. Thus, complications can be prevented in diabetic surgical patients by detecting cognitive dysfunction in the early stages, so that appropriate treatment can be initiated.

Anahtar Kelimeler

Cognitive dysfunction, Postoperative cognitive complications, Diabetes mellitus type 2

Kaynakça

• 1. Steinmetz J, Christensen KB, Lund T, Lohse N, Rasmussen LS; ISPOCD Group. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology. 2009 Mar;110(3):548-55. doi: 10.1097/ALN.0b013e318195b569. PMID: 19225398.
• 2. Rasmussen LS, Moller JT. Cognitive dysfunction after anesthesia. Curr Anaesth Crit Care. 1998;9:307-11. doi: 10.1016/S0953-7112(98)80019-7
• 3. Bedford PD. Adverse cerebral effects of anaesthesia on old people. Lancet. 1955 Aug 6;269(6884):259-63. doi: 10.1016/s0140-6736(55)92689-1. PMID: 13243706.
• 4. Ologunde R, Ma D. Do inhalational anesthetics cause cognitive dysfunction? Acta Anaesthesiol Taiwan. 2011 Dec;49(4):149-53. doi: 10.1016/j.aat.2011.11.001. Epub 2011 Dec 19. PMID: 22221688.
• 5. Gao L, Taha R, Gauvin D, Othmen LB, Wang Y, Blaise G. Postoperative cognitive dysfunction after cardiac surgery. Chest. 2005 Nov;128(5):3664-70. doi: 10.1378/chest.128.5.3664. PMID: 16304328.
• 6. Gögenur I, Bisgaard T, Burgdorf S, van Someren E, Rosenberg J. Disturbances in the circadian pattern of activity and sleep after laparoscopic versus open abdominal surgery. Surg Endosc. 2009 May;23(5):1026-31. doi: 10.1007/s00464-008-0112-9. Epub 2008 Oct 2. PMID: 18830755.
• 7. Terrando N, Eriksson LI, Ryu JK, Yang T, Monaco C, Feldmann M, et al. Resolving postoperative neuroinflammation and cognitive decline. Ann Neurol. 2011 Dec;70(6):986-95. doi: 10.1002/ana.22664. PMID: 22190370; PMCID: PMC4556354.
• 8. Dodds C, Allison J. Postoperative cognitive deficit in the elderly surgical patient. Br J Anaesth. 1998 Sep;81(3):449-62. doi: 10.1093/bja/81.3.449. PMID: 9861139.
• 9. Lachmann G, Feinkohl I, Borchers F, Ottens TH, Nathoe HM, Sauer AM, et al. Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction. Dement Geriatr Cogn Disord. 2018;46(3-4):193-206. doi: 10.1159/000492962. Epub 2018 Oct 16. PMID: 30326480.
• 10. Cowie CC, Rust KF, Ford ES, Eberhardt MS, Byrd-Holt DD, Li C, Williams DE, Gregg EW, Bainbridge KE, Saydah SH, Geiss LS. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006. Diabetes Care. 2009 Feb;32(2):287-94. doi: 10.2337/dc08-1296. Epub 2008 Nov 18. Erratum in: Diabetes Care. 2011 Oct;34(10):2338. PMID: 19017771; PMCID: PMC2628695.
• 11. Green A, Christian Hirsch N, Pramming SK. The changing world demography of type 2 diabetes. Diabetes Metab Res Rev. 2003 Jan-Feb;19(1):3-7. doi: 10.1002/dmrr.340. PMID: 12592640.
• 12. Kodl CT, Seaquist ER. Cognitive dysfunction and diabetes mellitus. Endocr Rev. 2008 Jun;29(4):494-511. doi: 10.1210/er.2007-0034. Epub 2008 Apr 24. PMID: 18436709; PMCID: PMC2528851.
• 13. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695-9. doi: 10.1111/j.1532-5415.2005.53221.x. Erratum in: J Am Geriatr Soc. 2019 Sep;67(9):1991. PMID: 15817019.
• 14. Selekler K, Cangöz B, Uluc S. Investigation of the distinguishing power of the Montreal Cognitive Assessment Scale in patients with mild cognitive impairment and Alzheimer's. Turkish Journal of Geriatrics. 2010;13:166-71.
• 15. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189-98. doi: 10.1016/0022-3956(75)90026-6. PMID: 1202204.
• 16. Güngen C, Ertan T, Eker E, Yaşar R, Engin F. Standardize Mini Mental test'in türk toplumunda hafif demans tanisinda geçerlik ve güvenilirliği [Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population]. Turk Psikiyatri Derg. 2002 Winter;13(4):273-81. Turkish. PMID: 12794644.
• 17. Abildstrom H, Rasmussen LS, Rentowl P, Hanning CD, Rasmussen H, Kristensen PA, Moller JT. Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly. ISPOCD group. International Study of Post-Operative Cognitive Dysfunction. Acta Anaesthesiol Scand. 2000 Nov;44(10):1246-51. doi: 10.1034/j.1399-6576.2000.441010.x. PMID: 11065205.
• 18. Monk TG, Weldon BC, Garvan CW, Dede DE, van der Aa MT, Heilman KM, Gravenstein JS. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008 Jan;108(1):18-30. doi: 10.1097/01.anes.0000296071.19434.1e. PMID: 18156878.
• 19. Fodale V, Santamaria LB, Schifilliti D, Mandal PK. Anaesthetics and postoperative cognitive dysfunction: a pathological mechanism mimicking Alzheimer's disease. Anaesthesia. 2010 Apr;65(4):388-95. doi: 10.1111/j.1365-2044.2010.06244.x. Epub 2010 Feb 5. PMID: 20136805.
• 20. Ahlgren E, Lundqvist A, Nordlund A, Aren C, Rutberg H. Neurocognitive impairment and driving performance after coronary artery bypass surgery. Eur J Cardiothorac Surg. 2003 Mar;23(3):334-40. doi: 10.1016/s1010-7940(02)00807-2. PMID: 12614803.
• 21. Bitsch MS, Foss NB, Kristensen BB, Kehlet H. Acute cognitive dysfunction after hip fracture: frequency and risk factors in an optimized, multimodal, rehabilitation program. Acta Anaesthesiol Scand. 2006 Apr;50(4):428-36. doi: 10.1111/j.1399-6576.2005.00899.x. PMID: 16548854.
• 22. Anwer HM, Swelem SE, el-Sheshai A, Moustafa AA. Postoperative cognitive dysfunction in adult and elderly patients--general anesthesia vs subarachnoid or epidural analgesia. Middle East J Anaesthesiol. 2006 Oct;18(6):1123-38. PMID: 17263267.
• 23. Rasmussen LS, Johnson T, Kuipers HM, Kristensen D, Siersma VD, Vila P, et al; ISPOCD2(International Study of Postoperative Cognitive Dysfunction) Investigators. Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand. 2003 Mar;47(3):260-6. doi: 10.1034/j.1399-6576.2003.00057.x. PMID: 12648190.
• 24. Fong HK, Sands LP, Leung JM. The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review. Anesth Analg. 2006 Apr;102(4):1255-66. doi: 10.1213/01.ane.0000198602.29716.53. PMID: 16551934.
• 25. Steinmetz J, Funder KS, Dahl BT, Rasmussen LS. Depth of anaesthesia and post-operative cognitive dysfunction. Acta Anaesthesiol Scand. 2010 Feb;54(2):162-8. doi: 10.1111/j.1399-6576.2009.02098.x. Epub 2009 Sep 17. PMID: 19764909.
• 26. Wu CL, Hsu W, Richman JM, Raja SN. Postoperative cognitive function as an outcome of regional anesthesia and analgesia. Reg Anesth Pain Med. 2004 May-Jun;29(3):257-68. doi: 10.1016/j.rapm.2003.11.007. PMID: 15138912.
• 27. Xiaohong, Zhao, Tan Yue, and Bao Juan. Clinical observation on relationship between insulin resistance and mild cognitive impairment. Stroke Nerv Dis. 2009; 16: 155–8.
• 28. Strachan MW, Price JF. Diabetes. Cognitive decline and T2DM--a disconnect in the evidence? Nat Rev Endocrinol. 2014 May;10(5):258-60. doi: 10.1038/nrendo.2014.38. Epub 2014 Apr 1. PMID: 24686200.
• 29. Reijmer YD, van den Berg E, Ruis C, Kappelle LJ, Biessels GJ. Cognitive dysfunction in patients with type 2 diabetes. Diabetes Metab Res Rev. 2010 Oct;26(7):507-19. doi: 10.1002/dmrr.1112. PMID: 20799243.
• 30. Strachan MW, Price JF. Diabetes. Cognitive decline and T2DM--a disconnect in the evidence? Nat Rev Endocrinol. 2014 May;10(5):258-60. doi: 10.1038/nrendo.2014.38. Epub 2014 Apr 1. PMID: 24686200.
• 31. Reijmer YD, van den Berg E, Ruis C, Kappelle LJ, Biessels GJ. Cognitive dysfunction in patients with type 2 diabetes. Diabetes Metab Res Rev. 2010 Oct;26(7):507-19. doi: 10.1002/dmrr.1112. PMID: 20799243.
• 32. Murkin JM. The role of CPB management in neurobehavioral outcomes after cardiac surgery. Ann Thorac Surg. 1995 May;59(5):1308-11. doi: 10.1016/0003-4975(95)00107-v. PMID: 7733758.
• 33. Nötzold A, Michel K, Khattab AA, Sievers HH, Hüppe M. Diabetes mellitus increases adverse neurocognitive outcome after coronary artery bypass grafting surgery. Thorac Cardiovasc Surg. 2006 Aug;54(5):307-12. doi: 10.1055/s-2006-924089. PMID: 16902877.
• 34. Tang N, Jiang R, Wang X, Wen J, Liu L, Wu J, Zhang C. Insulin resistance plays a potential role in postoperative cognitive dysfunction in patients following cardiac valve surgery. Brain Res. 2017 Feb 15;1657:377-82. doi: 10.1016/j.brainres.2016.12.027. Epub 2016 Dec 31. PMID: 28048971.
• 35. Feinkohl I, Winterer G, Pischon T. Diabetes is associated with risk of postoperative cognitive dysfunction: A meta-analysis. Diabetes Metab Res Rev. 2017 Jul;33(5). doi: 10.1002/dmrr.2884. Epub 2017 Feb 23. PMID: 28063267.
• 36. Kadoi Y, Saito S, Fujita N, Goto F. Risk factors for cognitive dysfunction after coronary artery bypass graft surgery in patients with type 2 diabetes. J Thorac Cardiovasc Surg. 2005 Mar;129(3):576-83. doi: 10.1016/j.jtcvs.2004.07.012. PMID: 15746741.
• 37. Crosby-Nwaobi RR, Sivaprasad S, Amiel S, Forbes A. The relationship between diabetic retinopathy and cognitive impairment. Diabetes Care. 2013 Oct;36(10):3177-86. doi: 10.2337/dc12-2141. Epub 2013 Apr 30. PMID: 23633523; PMCID: PMC3781499.
• 38. Cukierman-Yaffe T, Gerstein HC, Williamson JD, Lazar RM, Lovato L, Miller ME, et al; Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) Investigators. Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial. Diabetes Care. 2009 Feb;32(2):221-6. doi: 10.2337/dc08-1153. PMID: 19171735; PMCID: PMC2628683.
• 39. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008 Jun 12;358(24):2545-59. doi: 10.1056/NEJMoa0802743. Epub 2008 Jun 6. PMID: 18539917; PMCID: PMC4551392.
• 40. Yaffe K, Blackwell T, Whitmer RA, Krueger K, Barrett Connor E. Glycosylated hemoglobin level and development of mild cognitive impairment or dementia in older women. J Nutr Health Aging. 2006 Jul-Aug;10(4):293-5. PMID: 16886099.
• 41. Zhang Y, Bao HG, Lv YL, Si YN, Han L, Wang HY, et al. Risk factors for early postoperative cognitive dysfunction after colorectal surgery. BMC Anesthesiol. 2019 Jan 8;19(1):6. doi: 10.1186/s12871-018-0676-4. PMID: 30621601; PMCID: PMC6325738.
• 42. Inouye SK. Delirium in hospitalized older patients. Clin Geriatr Med. 1998 Nov;14(4):745-64. PMID: 9799477.
• 43. Rundshagen I. Postoperative cognitive dysfunction. Dtsch Arztebl Int. 2014 Feb 21;111(8):119-25. doi: 10.3238/arztebl.2014.0119. PMID: 24622758; PMCID: PMC3959222.