Clock Drawing Performance Slows for Older Adults After Total Knee Replacement Surgery

Hizel, Loren P.; Warner, Eric D; Wiggins, Margaret E.; Tanner, Jared J.; Parvataneni, Hari K.; Davis, Randall; Penney, Dana L.; Libon, David J.; Tighe, Patrick J.; Garvan, Cynthia Wilson; Price, Catherine C.

doi:10.1213/ane.0000000000003735

Cited by 19 publications

(20 citation statements)

References 25 publications

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“…These analyses in combination with digital clock-drawing technologies that include command and copy conditions may prove particularly valuable in large perioperative settings. 40 Sixth, we recognize that the value of clock drawing to copy relative to command for patient risk detection needs much more investigation and validation against a more comprehensive data set that includes many other medical and surgical–anesthetic factors. There are also 2 limitations of a statistical nature.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Rationale for Incorporating Frailty and Cognitive Screening Protocols in a Preoperative Anesthesia Clinic

Amini

Crowley

Hizel

et al. 2019

Anesthesia &Amp; Analgesia

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BACKGROUND-Advanced age, frailty, low education level, and impaired cognition are generally reported to be associated with postoperative cognitive complications. To translate research findings into hospital-wide preoperative assessment clinical practice, we examined the feasibility of implementing a preoperative frailty and cognitive assessment for all older adults electing surgical procedures in a tertiary medical center. We examined associations among age, education, frailty, and comorbidity with the clock and 3-word memory scores, estimated the prevalence of mild to major cognitive impairment in the presurgical sample, and examined factors related to hospital length of stay. METHODS-Medical staff screened adults ≥65 years of age for frailty, general cognition (via the clock-drawing test command and copy, 3-word memory test), and obtained years of education. Feasibility was studied in 2 phases: (1) a pilot phase involving 4 advanced nurse practitioners and (2) a 2-month implementation phase involving all preoperative staff. We tracked sources of missing data, investigated associations of study variables with measures of cognition, and used 2 approaches to estimate the likelihood of dementia in our sample (ie, using extant data and logistic regression modeling and using Mini-Cog cut scores). We explored which protocol variables related to hospital length of stay. RESULTS-The final implementation phase sample included 678 patients. Clock and 3-word memory scores were significantly associated with age, frailty, and education. Education, clock scores, and 3-word scores were not significantly different by surgery type. Likelihood of preoperative cognitive impairment was approximately 20%, with no difference by surgery type. Length of stay was significantly associated with preoperative comorbidity and performance on the clock copy condition. CONCLUSIONS-Frailty and cognitive screening protocols are feasible and provide information for perioperative care planning. Challenges to clinical adaptation include staff training, missing data, and additional administration time. These challenges appear minimal relative to the benefits of identifying frailty and cognitive impairment in a group at risk for negative postoperative cognitive outcome. Research repeatedly shows that predictors of delirium, cognitive decline, and mortality after surgical procedures with anesthesia include (1) frailty, 1 (2) fewer years of formal education, 2,3 and (3) reduced preoperative cognitive abilities, 1 particularly in the domains of memory

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Section: Discussionmentioning

confidence: 99%

Feasibility and Rationale for Incorporating Frailty and Cognitive Screening Protocols in a Preoperative Anesthesia Clinic

Amini

Crowley

Hizel

et al. 2019

Anesthesia &Amp; Analgesia

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“…Future work needs to examine rater reliability across a wider range of neurocognitive pathologies within the perioperative setting. Perioperative scoring approaches should also be compared to more modern CDT approaches such as the digital clock drawing task which collects well over 10k variables per patient 11 .…”

Section: Discussionmentioning

confidence: 99%

Considerations for Clock Drawing Scoring Systems in Perioperative Anesthesia Settings

Frei¹,

Woodward²,

Zhang³

et al. 2019

Anesthesia &Amp; Analgesia

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The Clock Drawing Test is a cognitive screening tool gaining popularity in the perioperative setting. We compared three common scoring systems:1) the Montreal Cognitive Assessment, 2) the Mini-Cog,and 3) Libon et al. (1996).Three novice raters acquired inter- and intra-rater reliability for each scoring system and then scored 738 preoperative clock drawings with each scoring system. Final scores correlated with each other but with notable discrepancies indicating the need to attend to inter and intra-rater reliability when implementing any scoring approach in a clinical setting.

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“…This dCDT system was designed to capture a range of drawing variables, including drawing latencies and number of strokes, as well as storing the completed drawing suitable for conventional scoring (eg MoCA clock drawing score). For the purposes of this study, we used the total time spent drawing (including time between drawing strokes) referred to as “dCDT time” and a total score based on MoCA clock drawing criteria 22,23 . We selected these variables as they most closely reflect the variables of interest in the traditional paper and pencil test.…”

Section: Methodsmentioning

confidence: 99%

A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: A feasibility study

Buckley

Atkins

Fortunato

et al. 2020

Acta Anaesthesiol Scand

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Background We developed a digital clock drawing test (dCDT), an adaptation of the original pen and paper clock test, that may be advantageous over previous dCDTs in the perioperative environment. We trialed our dCDT on a tablet device in the preoperative period to determine the feasibility of administration in this setting. To assess the clinical utility of this test, we examined the relationship between the performance on the test and compared derived digital clock measures with the 4 A's Test (4AT), a delirium and cognition screening tool. Methods We recruited a sample of 102 adults aged 65 years and over presenting for elective surgery in a single tertiary hospital. Participants completed the 4AT, followed by both command and copy clock conditions of the dCDT. We recorded time‐based clock‐drawing metrics, alongside clock replications scored using the Montreal Cognitive Assessment (MoCA) clock scoring criteria. Results The dCDT had an acceptance rate of 99%. After controlling for demographic variables and prior tablet use, regression analyses showed higher 4AT scores were associated with greater dCDT time (seconds) for both command (β = 8.2, P = .020) and copy clocks (β = 12, P = .005) and lower MoCA‐based clock scores in both command (OR = 0.19, P = .001) and copy conditions (OR = 0.14, P = .012). Conclusion The digital clock drawing test is feasible to administer and is highly acceptable to older adults in a preoperative setting. We demonstrated a significant association between both the dCDT time and clock score metrics, with the established 4AT. Our results provide convergent validity of the dCDT in the preoperative setting.

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Clock Drawing Performance Slows for Older Adults After Total Knee Replacement Surgery

Cited by 19 publications

References 25 publications

Feasibility and Rationale for Incorporating Frailty and Cognitive Screening Protocols in a Preoperative Anesthesia Clinic

Feasibility and Rationale for Incorporating Frailty and Cognitive Screening Protocols in a Preoperative Anesthesia Clinic

Considerations for Clock Drawing Scoring Systems in Perioperative Anesthesia Settings

A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: A feasibility study

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