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The utility of remote cognitive screening tools in identifying cognitive impairment in older surgical patients: An observational cohort study.
Yan, Ellene; Butris, Nina; Alhamdah, Yasmin; Kapoor, Paras; Lovblom, Leif Erik; Islam, Sazzadul; Saripella, Aparna; Wong, Jean; Tang-Wai, David F; Mah, Linda; Alibhai, Shabbir M H; Tartaglia, Maria Carmela; He, David; Chung, Frances.
Afiliação
  • Yan E; Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada.
  • Butris N; Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada.
  • Alhamdah Y; Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada.
  • Kapoor P; Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada.
  • Lovblom LE; Biostatistics Department, University Health Network, Toronto, ON, Canada.
  • Islam S; Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Saripella A; Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Wong J; Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada.
  • Tang-Wai DF; Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • Mah L; Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Geriatric Psychiatry, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, ON, Canada.
  • Alibhai SMH; Temerty Faculty of Medicine, University of Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
  • Tartaglia MC; Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • He D; Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
  • Chung F; Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada. Electronic address: frances.chung@uhn.ca.
J Clin Anesth ; 97: 111557, 2024 Jul 23.
Article em En | MEDLINE | ID: mdl-39047531
ABSTRACT
STUDY

OBJECTIVES:

To determine the prevalence of suspected cognitive impairment using the Centers for Disease Control and Prevention (CDC) cognitive question, Ascertain Dementia Eight-item Questionnaire (AD8), Modified Telephone Interview for Cognitive Status (TICS-M), and Telephone Montreal Cognitive Assessment (T-MoCA), the agreement between each tool beyond chance, and the risk factors associated with a positive screen.

DESIGN:

Multicenter prospective study.

SETTING:

Remote preoperative assessments. PATIENTS 307 non-cardiac surgical patients aged ≥65 years. MEASUREMENTS Prevalence, Cohen's kappa (κ). MAIN

RESULTS:

The T-MoCA detected the highest prevalence of suspected cognitive impairment (28%), followed by the AD8 (17%), CDC cognitive question (9%), and TICS-M (6%). The four screening tools showed poor agreement beyond chance with one another, with the CDC cognitive question and AD8 approaching the threshold for weak agreement (κ = 0.39). Depression was associated with screening positive on the CDC cognitive question (OR 2.81; 95% CI 1.04, 7.68). Obstructive sleep apnea (OSA) (OR 3.10; 95% CI 1.26, 7.71) and functional disability (OR 3.74; 95% CI 1.34, 11.11) were associated with a positive AD8 screen. Older age (OR 1.56; 95% CI 1.01, 2.41), male sex (OR 3.08; 95% CI 1.09, 9.40), and higher pain level (OR 1.21; 95% CI 1.01, 1.47) were associated with a positive TICS-M screen. Similarly, older age (OR 1.33; 95% CI 1.03, 1.73), male sex (OR 2.02; 95% CI 1.09, 3.83), and higher pain level (OR 1.15; 95% CI 1.02, 1.30) were associated with a positive T-MoCA screen.

CONCLUSIONS:

The CDC cognitive question, AD8, TICS-M, and T-MoCA were easily implemented during preoperative assessment among older surgical patients. OSA, functional disability, and depression were associated with complaints on the CDC cognitive question and AD8. Older age, male sex, and higher pain level were associated with screening positive on the TICS-M and T-MoCA. Early remote cognitive screening may enhance risk stratification of vulnerable patients.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: J Clin Anesth Assunto da revista: ANESTESIOLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Canadá
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: J Clin Anesth Assunto da revista: ANESTESIOLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Canadá