title: Influence and Impact of Cognitive Trajectories on Outcome in Patients Undergoing Radical Cystectomy: An Observational Study.
abstract: OBJECTIVE
  To evaluate cognitive trajectories after radical cystectomy and their impact on surgical outcomes, including urinary continence.
  
  
  METHODS
  Ninety patients received cognitive testing using the Mini Mental State Examination before open radical cystectomy as well as 3 days and 2 weeks after surgery. Based on the Mini Mental State Examination changes ≥3 points between the three time points, five cognitive trajectories emerged (stable cognition, persistent or transient deterioration, or persistent or transient improvement). Surgical outcomes were assessed 90 days, 6 months, and 1 year postoperatively.
  
  
  RESULTS
  Mean age was 67.9 ± 9.3 years (range 40-88 years). Sixty-six patients (73.3%) had stable cognition, 9 patients (10.0%) had persistent deterioration and 7 patients (7.8%) had transient deterioration, 5 patients (5.6%) had persistent improvement and 3 patients (3.3%) had transient improvement. An impaired preoperative cognition was the only significant risk factor of short-term cognitive deterioration (odds ratio adjusted for age and sex 9.4, 95% confidence interval 1.6-56.5, P = .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 (odds ratio adjusted for age and sex 5.1, 95% confidence interval 1.1-22.4, P = .032).
  
  
  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.
authors.affiliation: Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Schoenenberger
authors.affiliation: Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland.
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Burkhard
authors.affiliation: Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland.
authors.forename: George N
authors.initials: GN
authors.lastname: Thalmann
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, Bern, Switzerland. Electronic address: patrick.wuethrich@insel.ch.
authors.forename: Patrick Y
authors.initials: PY
authors.lastname: Wuethrich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology; D015653:Cystectomy / Q000379:methods / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000523:psychology / Q000601:surgery*