Deborah J Culley1, Devon Flaherty, Srini Reddy, Margaret C Fahey, James Rudolph, Chuan Chin Huang, Xiaoxia Liu, Zhongcong Xie, Angela M Bader, Bradley T Hyman, Deborah Blacker, Gregory Crosby. 1. From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; †University of Cincinnati College of Medicine, Cincinnati, Ohio; ‡ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; §Department of Anesthesiology, Perioperative and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; ∥Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; ¶ Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School and Harvard School of Public Health, Boston, Massachusetts; and #Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
Abstract
BACKGROUND: Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. We hypothesized that preoperative cognitive screening can be performed in a busy preadmission evaluation center and that cognitive impairment is prevalent in elective geriatric surgical patients. METHODS: We approached 311 patients aged 65 years and older presenting for preoperative evaluation before elective surgery in a prospective, observational, single-center study. Forty-eight patients were ineligible, and 63 declined. The remaining 200 were randomly assigned to the Mini-Cog (N =100) or Clock-in-the-Box [CIB; N = 100)] test. Study staff administered the test in a quiet room, and 2 investigators scored the tests independently. Probable cognitive impairment was defined as a Mini-Cog ≤ 2 or a CIB ≤ 5. RESULTS: The age of consenting patients was 73.7 ± 6.4 (mean ± SD) years. There were no significant differences between patients randomly assigned to the Mini-Cog and CIB test in age, weight, gender, education, ASA physical status, or Charlston Index. Overall, 23% of patients met criteria for probable cognitive impairment, and prevalence was virtually identical regardless of the test used; 22% screened with the Mini-Cog and 23% screened with the CIB scored as having probable cognitive impairment (P = 1.0 by χ analysis). Both tests had good interrater reliability (Krippendroff α = 0.86 [0.72-0.93] for Mini-Cog and 1 for CIB). CONCLUSIONS: Preoperative cognitive screening is feasible in most geriatric elective surgical patients and reveals a substantial prevalence of probable cognitive impairment in this population.
BACKGROUND: Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. We hypothesized that preoperative cognitive screening can be performed in a busy preadmission evaluation center and that cognitive impairment is prevalent in elective geriatric surgical patients. METHODS: We approached 311 patients aged 65 years and older presenting for preoperative evaluation before elective surgery in a prospective, observational, single-center study. Forty-eight patients were ineligible, and 63 declined. The remaining 200 were randomly assigned to the Mini-Cog (N =100) or Clock-in-the-Box [CIB; N = 100)] test. Study staff administered the test in a quiet room, and 2 investigators scored the tests independently. Probable cognitive impairment was defined as a Mini-Cog ≤ 2 or a CIB ≤ 5. RESULTS: The age of consenting patients was 73.7 ± 6.4 (mean ± SD) years. There were no significant differences between patients randomly assigned to the Mini-Cog and CIB test in age, weight, gender, education, ASA physical status, or Charlston Index. Overall, 23% of patients met criteria for probable cognitive impairment, and prevalence was virtually identical regardless of the test used; 22% screened with the Mini-Cog and 23% screened with the CIB scored as having probable cognitive impairment (P = 1.0 by χ analysis). Both tests had good interrater reliability (Krippendroff α = 0.86 [0.72-0.93] for Mini-Cog and 1 for CIB). CONCLUSIONS: Preoperative cognitive screening is feasible in most geriatric elective surgical patients and reveals a substantial prevalence of probable cognitive impairment in this population.
Authors: Serge Gauthier; Barry Reisberg; Michael Zaudig; Ronald C Petersen; Karen Ritchie; Karl Broich; Sylvie Belleville; Henry Brodaty; David Bennett; Howard Chertkow; Jeffrey L Cummings; Mony de Leon; Howard Feldman; Mary Ganguli; Harald Hampel; Philip Scheltens; Mary C Tierney; Peter Whitehouse; Bengt Winblad Journal: Lancet Date: 2006-04-15 Impact factor: 79.321
Authors: John Riley McCarten; Pauline Anderson; Michael A Kuskowski; Susan E McPherson; Soo Borson; Maurice W Dysken Journal: J Am Geriatr Soc Date: 2012-02 Impact factor: 5.562
Authors: Pim van den Dungen; Harm W M van Marwijk; Henriëtte E van der Horst; Eric P Moll van Charante; Janet Macneil Vroomen; Peter M van de Ven; Hein P J van Hout Journal: Int J Geriatr Psychiatry Date: 2011-05-30 Impact factor: 3.485
Authors: Emily Finlayson; Shoujun Zhao; W John Boscardin; Brant E Fries; C Seth Landefeld; R Adams Dudley Journal: J Am Geriatr Soc Date: 2012-03-16 Impact factor: 5.562
Authors: James L Rudolph; Sharon K Inouye; Richard N Jones; Frances M Yang; Tamara G Fong; Sue E Levkoff; Edward R Marcantonio Journal: J Am Geriatr Soc Date: 2010-03-22 Impact factor: 5.562
Authors: Franchesca Arias; Michael Riverso; Shellie-Anne Levy; Rebecca Armstrong; David S Estores; Patrick Tighe; Catherine C Price Journal: Anesth Analg Date: 2019-09 Impact factor: 5.108
Authors: Shawna Amini; Samuel Crowley; Loren Hizel; Franchesca Arias; David J Libon; Patrick Tighe; Chris Giordano; Cynthia W Garvan; F Kayser Enneking; Catherine C Price Journal: Anesth Analg Date: 2019-09 Impact factor: 5.108
Authors: Bailey W Frei; Kristen T Woodward; Mitchell Y Zhang; Shawna Amini; Patrick Tighe; Cynthia W Garvan; Chris Giordano; Catherine C Price Journal: Anesth Analg Date: 2019-05 Impact factor: 5.108
Authors: Franchesca Arias; Margaret Wiggins; Richard D Urman; Rebecca Armstrong; Kurt Pfeifer; Angela M Bader; David J Libon; Anita Chopra; Catherine C Price Journal: Perioper Care Oper Room Manag Date: 2020-01-25
Authors: Loren P Hizel; Eric D Warner; Margaret E Wiggins; Jared J Tanner; Hari Parvataneni; Randall Davis; Dana L Penney; David J Libon; Patrick Tighe; Cynthia W Garvan; Catherine C Price Journal: Anesth Analg Date: 2019-07 Impact factor: 5.108
Authors: Deborah J Culley; Devon Flaherty; Margaret C Fahey; James L Rudolph; Houman Javedan; Chuan-Chin Huang; John Wright; Angela M Bader; Bradley T Hyman; Deborah Blacker; Gregory Crosby Journal: Anesthesiology Date: 2017-11 Impact factor: 7.892
Authors: Maria J Susano; Rachel H Grasfield; Matthew Friese; Bernard Rosner; Gregory Crosby; Angela M Bader; James D Kang; Timothy R Smith; Yi Lu; Michael W Groff; John H Chi; Francine Grodstein; Deborah J Culley Journal: Anesthesiology Date: 2020-12-01 Impact factor: 7.892