Preoperative assessment of cognitive function and risk assessment of cognitive impairment in elderly patients with orthopedics: a cross-sectional study

Abstract

Background: Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. Nevertheless, cognitive impairment in a large proportion of geriatric patients has not been well identified and diagnosed. Methods: This is a cross-sectional study. Mini-mental state examination scale was used to assess the cognitive function of elderly patients aged ≥65 years undergoing orthopedic surgery preoperatively. The baseline, living habits and laboratory examination results of two groups were compared, and a multivariable logistic regression model was used to identify independent predictors of preoperative cognitive impairment. Results: A total of 374 elderly patients with orthopedic surgery indications met the inclusion criteria, and 28.61% of them had preoperative cognitive impairment. Multivariable logistic regression analysis showed that age (OR = 1.089, P < 0.001), subjective sleep disorders (OR = 1.996, P = 0.021), atherosclerosis (OR = 2.367, P = 0.017), and high cholesterol level (OR = 1.373, P = 0.028) were independent risk factors for preoperative cognitive impairment, while high education level performed as a protective factor (compared with the illiterate group, primary school group: OR = 0.413, P = 0.009; middle school or above group: OR = 0.120, P < 0.001). Conclusions: The prevalence of preoperative cognitive dysfunction in geriatric elective orthopedic surgical patients was high. Our study identified venerable age, low level of education, subjective sleep disorders, atherosclerosis, and high cholesterol level as risk factors for preoperative cognitive impairment in these patients. Understanding these risk factors contributes to assisting in prevention and directed interventions for the high-risk population.

Risk assessment of perioperative neurocognitive disorders, where are we now?

“…In a cross-sectional study, Gan et al [26] The incidence of preexisting cognitive deficits in elderly patients is therefore considerable and there is a relevant risk of overlooking them. Hence, both European and American Guidelines recommend cognitive screening before surgery [3,28], but little is known about the extent to which this is implemented.…”

“…In a cross-sectional study, Gan et al [26] investigated cognitive impairment of elderly patients (aged ≥ 65 years) scheduled for elective orthopaedic surgery using the Mini-Mental State Examination (MMSE). They observed preoperative cognitive impairment in 28.6% of patients and identified age, subjective sleep disorder, atherosclerosis, high cholesterol level and low education level as independent risk factors.…”

Screening for Mild Cognitive Impairment in the Preoperative Setting: A Narrative Review

“…In addition, the administration time of the MMSE may sometimes exceed 15 min [ 29 ], which makes it not optimal for use as a quick screening tool in the preoperative setting [ 29 ]. Furthermore, the efficacy of routine use of cognitive screening tools in perioperative patients has not been fully established [ 30 , 31 ]. Therefore, currently, preoperative cognitive screening to evaluate baseline cognitive functioning is not routinely performed in the preoperative assessment.…”

The effectiveness of eye tracking in the diagnosis of cognitive disorders: A systematic review and meta-analysis

“…Cognitive function includes learning and memory, language, visuospatial, executive, and psychomotor [ 1 ]. Cognitive impairment (CI) was considered as injury in two or more areas of cognition [ 2 ], prevalence of CI is as high as 35–50% [ 3 ]. The rising incidence of CI has become a serious health problem due to an aging population [ 4 ].…”