Cognitive impairment assessment and interventions to optimize surgical patient outcomes

Hasan, Tasneem F.; Kelley, Roger E.; Cornett, Elyse M.; Urman, Richard D.; Kaye, Alan D.

doi:10.1016/j.bpa.2020.05.005

Cited by 19 publications

(31 citation statements)

References 215 publications

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“…Postoperative delirium (POD) and POCD have long been recognized as potential complications of anesthesia and surgery, with risk factors that include patient age, anesthetic drugs, and type of surgery ( 2 , 3 ). The incidence of POD may vary depending on the type of surgery, with a previous study reporting an incidence of POD ranging from 3 to 47% following major cardiac surgery ( 4 ). Similarly, another study estimated the incidence of POD at 26–53% and 3-month POCD at about 10% ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Is Perioperative Dexmedetomidine Associated With a Reduced Risk of Perioperative Neurocognitive Disorders Following Cardiac Surgery? A Systematic Review and Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials

2021

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Background: To assess the effect of dexmedetomidine on the reducing risk of perioperative neurocognitive disorders (PNDs) following cardiac surgery.Methods: A systematic review and meta-analysis with trial sequential analysis (TSA) of randomized controlled trials were performed. PubMed, Embase, Cochrane Library, and CNKI databases (to August 16, 2020) were searched for relevant articles to analyze the incidence of PND for intraoperative or postoperative dexmedetomidine administration after cardiac surgery. PND included postoperative cognitive dysfunction (POCD) and postoperative delirium (POD).Results: A total of 24 studies with 3,610 patients were included. Compared with the control group, the incidence of POD in the dexmedetomidine group was significantly lower (odds ratio [OR]: 0.59, 95% CI: 0.43–0.82, P = 0.001), with firm evidence from TSA. Subgroup analyses confirmed that dexmedetomidine reduced the incidence of POD with firm evidence following coronary artery bypass grafting surgery (OR: 0.45, 95% CI: 0.26–0.79, P = 0.005), and intervention during the postoperative period (OR: 0.48, 95% CI: 0.34–0.67, P < 0.001). Furthermore, the incidence of POD in the dexmedetomidine group was also decreased in mixed cardiac surgery (OR: 0.68, 95% CI: 0.47–0.98, P = 0.039). Irrespective of whether “Confusion Assessment Method/Confusion Assessment Method for intensive care unit” or “other tools” were used as diagnostic tools, the results showed a decreased risk of POD in the dexmedetomidine group. There was no significant difference in the incidence of POCD (OR: 0.47, 95% CI: 0.22–1.03, P = 0.060) between the two groups, but this result lacked firm evidence from TSA.Conclusion: The administration of dexmedetomidine during the perioperative period reduced the incidence of POD in patients after cardiac surgery, but there was no significant benefit in the incidence of POCD. The effect of dexmedetomidine on the incidence of POD or POCD following different types of surgery and the optimal dose and timing of dexmedetomidine warrant further investigation.Trial registration: PROSPERO registration number: CRD42020203980. Registered on September 13, 2020.

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Section: Introductionmentioning

confidence: 99%

Is Perioperative Dexmedetomidine Associated With a Reduced Risk of Perioperative Neurocognitive Disorders Following Cardiac Surgery? A Systematic Review and Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials

2021

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“…There are various screening tools that are used for pre-operative evaluation of cognitive impairment, such as the MMSE, the MoCA, the Mini-Cog, and the Clock Drawing Test (Arias et al, 2020;Hasan et al, 2020). The MMSE (Folstein et al, 1975) and the MoCA (Nasreddine et al, 2005) are two of the most widely used cognitive screening tools (Cheng et al, 2012;Evered et al, 2011;Lingehall et al, 2017;Partridge et al, 2014;Smith & Yeow, 2016), both in clinical settings and in research.…”

Section: Introductionmentioning

confidence: 99%

“…Pre‐operative assessment of cognitive impairment is vital for predicting, preventing, monitoring, and early recognition of the development of postoperative complications, so that targeted interventions can be introduced early to optimize the postoperative outcome of older surgical patients (Hasan et al., 2020; Oresanya et al., 2014). Given the number of older people undergoing surgery has increased even faster than the rate of population ageing over the past two decades (Jablonski & Urman, 2019), routinely screen cognitive function for older patients pre‐operatively has been urgently proposed (Arias et al., 2020; Hasan et al., 2020).…”

Section: Introductionmentioning

confidence: 99%

“…The MoCA is feasible for identifying patients with mild‐to‐moderate cognitive impairment who are at risk of developing postoperative cognitive dysfunction (Puustinen et al., 2016). No single screening test is therefore ‘better’ than the other, so selection often comes down to clinician preference (Hasan et al., 2020). Administering both the scales in the same session might put unnecessary stress on the patients and might not be feasible in busy clinical settings.…”

Section: Introductionmentioning

confidence: 99%

“…Previous findings showed that the relationship between MMSE and MoCA scores may vary across dementia subtypes, suggesting that caution is necessary in interpreting previously published conversions in heterogeneous clinical populations (Bergeron et al., 2017; Wong et al., 2018). It is therefore important to consider factors that might influence cognitive performance in surgical patients, such as receiving pre‐operative chemical therapy, pain, emotional problems, and metabolic or nutritional problems (Hasan et al., 2020).…”

Section: Introductionmentioning

confidence: 99%

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Conversion between Mini‐Mental State Examination and Montreal Cognitive Assessment scores in older adults undergoing selective surgery using Rasch analysis

Chen

Wen

Wang

et al. 2020

Journal of Advanced Nursing

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Aims: To develop and validate a conversion table between the MMSE and the MoCA using Rasch analysis in older adults undergoing selective surgery and examine its diagnostic accuracy in detecting cognitive impairment. Design: Cross-sectional study. Methods: Older patients [N = 129; age 66.0 (4.6) years, education 7.7 (3.5) years] undergoing elective surgery were recruited from December 2017 to June 2018. All participants completed the MMSE and MoCA and 113 of them completed a battery of neuropsychological tests. Common person linking based on Rasch analysis was performed to develop the conversion table. The conversions were validated by calculating the intraclass correlation coefficient (ICC), score differences between actual and converted scores, and root mean squared error of the difference (RMSE). The diagnostic accuracy of the conversions for detecting cognitive impairment was also tested. Results: The MoCA [person measure: 1.3 (1.1) logits] was better targeted to the patients than the MMSE [person measure: 3.2 (1.3) logits]. Conversion from MoCA to MMSE scores (ICC 0.84, 95% CI 0.77-0.88; RMSE 1.36) was more precise than conversion from MMSE to MoCA (ICC 0.82, 95% CI 0.75-0.87; RMSE 2.56). Conversion from MoCA to MMSE demonstrated better diagnostic accuracy in detecting cognitive impairment than the actual MMSE, whereas conversion from MMSE to MoCA exhibited the opposite pattern. Conclusion: Conversion from MoCA to MMSE was more precise and had better diagnostic accuracy in detecting pre-operative cognitive impairment in older patients undergoing selective surgery than conversion from MMSE into MoCA. Impact: The finding is useful for interpreting, comparing, and integrating cognitive measurements in surgical settings and clinical research. Statistically sound conversion between MoCA and MMSE based on Rasch analysis is now possible for surgical setting and clinical research.

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Research progress of postoperative cognitive dysfunction in cardiac surgery under cardiopulmonary bypass

Zhuang

Xu²,

Zheng

et al. 2023

Ibrain

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Cardiopulmonary bypass (CPB) is often used in cardiothoracic surgery because its nonphysiological state causes pathophysiological changes in the body, causing multiorgan and multitissue damage to varying degrees. Postoperative cognitive dysfunction (POCD) is a common central nervous system complication after cardiac surgery. The etiology and mechanism of POCD are not clear. Neuroinflammation, brain mitochondrial dysfunction, cerebral embolism, ischemia, hypoxia, and other factors are related to the pathogenesis of POCD. There is a close relationship between CPB and POCD, as CPB can cause inflammation, hypoxia and reperfusion injury, and microemboli formation, all of which can trigger POCD. POCD increases medical costs, seriously affects patients' quality of life, and increases mortality. Currently, there is a lack of effective treatment methods for POCD. Commonly used methods include preoperative health management, reducing inflammation response during surgery, preventing microemboli formation, and implementing individualized rehabilitation programs after surgery. Strengthening preventive measures can minimize the occurrence of POCD and its adverse effects.

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Cognitive impairment assessment and interventions to optimize surgical patient outcomes

Cited by 19 publications

References 215 publications

Is Perioperative Dexmedetomidine Associated With a Reduced Risk of Perioperative Neurocognitive Disorders Following Cardiac Surgery? A Systematic Review and Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials

Is Perioperative Dexmedetomidine Associated With a Reduced Risk of Perioperative Neurocognitive Disorders Following Cardiac Surgery? A Systematic Review and Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials

Conversion between Mini‐Mental State Examination and Montreal Cognitive Assessment scores in older adults undergoing selective surgery using Rasch analysis

Research progress of postoperative cognitive dysfunction in cardiac surgery under cardiopulmonary bypass

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