Comparison of Postoperative Cognitive Decline Using the Mini-Mental State Examination and Montreal Cognitive Assessment After Minor Elective Surgery in Elderly

Abstract

Introduction and aimPostoperative cognitive dysfunction (POCD) is an important complication associated with increased morbidity, mortality, and reduced quality of life. Generally, studies have focused on major surgery so there is little evidence of the incidence of cognitive dysfunction in minor surgery. We aimed to compare the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in terms of detecting cognitive decline in elderly patients after elective inguinal herniorrhaphy procedure with general or spinal anesthesia. Material and methodsThis observational study was conducted from June 2014 to March 2015 at Ankara Numune Education and Research Hospital. The type of anesthesia was determined according to the anesthesiologist's preference who is blind to the study. Patients were grouped according to anesthesia received: general or spinal anesthesia. The MMSE and MoCA were evaluated presurgery and 24 hours after the operation. ResultsThe postoperative (24th hour) MMSE scores of patients (26.23±2.77) were significantly lower than the preoperative scores (27.17±1.93) in only the general anesthesia group (p =0.003). The postoperative (24th hour) MoCA scores (22.87±3.88 for general and 23.13±4.08 for spinal anesthesia) were significantly lower than the preoperative scores (24.32±3.19 for general and 24.35±2.84 for spinal anesthesia) in both the general and spinal anesthesia groups (p =0.000 and 0.019, respectively). The incidence of postoperative cognitive dysfunction was 32.9% using the MoCA and 15.2% using the MMSE (p=0,018). ConclusionEarly POCD is an important problem after elective minor surgeries, even with spinal anesthesia, in elderly patients. The MoCA is an alternative tool that can be more sensitive than the MMSE to identify cognitive decline in elderly patients undergoing minor surgeries under both general and spinal anesthesia.

Dexmedetomidine nasal administration improves perioperative sleep quality and neurocognitive deficits in elderly patients undergoing general anesthesia

“…The higher the score, the higher the sleep quality star. Cognitive function was tested by Mini-Mental State Examinon (MMSE) and confusion assessment method (CAM) before surgery and at 1, 3 and 5 days after surgery [ 16 ]. The MMSE is the most commonly used cognitive screening scale in the world and provides simple ratings of orientation, memory, language, computation, and attention.…”

Effectiveness of dexmedetomidine on postoperative cognitive dysfunction in elderly patients with fracture: A systematic review

“…Primary outcome included mini-mental state examination (MMSE). [31,32] This tool covers 7 domains, consisting of 30 items. Each item ranges from 0 to 1, and the total score ranges from 0 to 30, with a lower score indicating worse condition.…”

“…Each item ranges from 0 to 1, and the total score ranges from 0 to 30, with a lower score indicating worse condition. [31,32] Secondary outcomes consisted of total occurrence rate of POCD (TORPOCD), occurrence rate of delirium (ORD), visual analogue scale (VAS) and occurrence rate of adverse events (ORAE). The scale of VAS ranges from 0 (no pain) to 10 (worst pain), with a higher score indicating worse pain intensity.…”