Sensitivity and specificity of the animal fluency test for predicting postoperative delirium

Long, L. Stephen; Wolpaw, Jed; Leung, Jacqueline M.

doi:10.1007/s12630-014-0306-7

Cited by 26 publications

(16 citation statements)

References 17 publications

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“…14 Category fluency has also been used as a cognitive screening test in this setting with similar results in terms of prevalence of probable cognitive impairment preoperatively and association with delirium postoperatively but selection bias is possible since about half of eligible patients were not screened. 43 It is important to emphasize in this context that no single cognitive test, administered at a single time, can diagnose MCI or dementia. Therefore, by itself, a low preoperative MiniCog score is not enough to diagnose or label a patient as having a memory disorder.…”

Section: Discussionmentioning

confidence: 99%

Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients

et al. 2017

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Background The American College of Surgeons and the American Geriatrics Society have suggested that preoperative cognitive screening should be performed in older surgical patients. We hypothesized that unrecognized cognitive impairment in patients without a history of dementia is a risk factor for development of postoperative complications. Methods We enrolled 211 patients 65 yr of age or older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement. Patients were cognitively screened preoperatively using the Mini-Cog and demographic, medical, functional, and emotional/social data were gathered using standard instruments or review of the medical record. Outcomes included discharge to place other than home (primary outcome), delirium, in-hospital medical complications, hospital length-of-stay, 30-day emergency room visits, and mortality. Data were analyzed using univariate and multivariate analyses. Results Fifty of 211 (24%) patients screened positive for probable cognitive impairment (Mini-Cog less than or equal to 2). On age-adjusted multivariate analysis, patients with a Mini-Cog score less than or equal to 2 were more likely to be discharged to a place other than home (67% vs. 34%; odds ratio = 3.88, 95% CI = 1.58 to 9.55), develop postoperative delirium (21% vs. 7%; odds ratio = 4.52, 95% CI = 1.30 to 15.68), and have a longer hospital length of stay (hazard ratio = 0.63, 95% CI = 0.42 to 0.95) compared to those with a Mini-Cog score greater than 2. Conclusions Many older elective orthopedic surgical patients have probable cognitive impairment preoperatively. Such impairment is associated with development of delirium postoperatively, a longer hospital stay, and lower likelihood of going home upon hospital discharge.

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Section: Discussionmentioning

confidence: 99%

Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients

et al. 2017

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“…Still, we cannot exclude the possibility that other brief instruments could work as well or better in the presurgical setting. (14,26,27,44–47) As screening instruments, the Mini-Cog and CIB will inevitably yield false positives and negatives. Someone falsely labeled as impaired may elect to forgo elective surgery for fear of having cognitive impairment afterward but those who proceed will likely just receive increased vigilance (e.g., geriatric consultation, more careful monitoring during anesthesia, joint discharge instructions), and those with undetected impairment will be no worse off than our patients are currently.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study

Culley

Flaherty

Reddy

et al. 2016

Anesthesia &Amp; Analgesia

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Background Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. We hypothesized that preoperative cognitive screening can be performed in a busy preadmission evaluation center and that cognitive impairment is prevalent in elective geriatric surgical patients. Methods We approached 311 patients ≥ 65 years-old presenting for preoperative evaluation prior to elective surgery in a prospective, observational, single-center study. Forty-eight patients were ineligible and 63 declined. The remaining 200 were randomized to the Mini-Cog (N =100) or Clock-in-the-Box [CIB; N = 100)] test. Study staff administered the test in a quiet room and 2 investigators scored the tests independently. Probable cognitive impairment was defined as a Mini-Cog ≤ 2 or a CIB ≤ 5. Results The age of consenting patients was 73.7± 6.4 (mean ± SD) years. There were no significant differences between patients randomized to the Mini-Cog or CIB test in age, weight, gender, education, ASA physical status or Charlston Index. Overall, 23% of patients met criteria for probable cognitive impairment, and prevalence was virtually identical regardless of the test used; 22% screened with the Mini-Cog and 23% screened with the CIB scored as having probable cognitive impairment (P =1.0 by Chi Square analysis). Both tests had good inter-rater reliability (Krippendroff's alpha = 0.86 (0.72–0.93) for Mini-Cog and 1 (1-1) for CIB). Conclusions Preoperative cognitive screening is feasible in most geriatric elective surgical patients and reveals a substantial prevalence of probable cognitive impairment in this population.

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“…There are myriad reasons for this, but one is the perception that such screening is unduly burdensome and time-consuming for a surgical setting. 8,[11][12][13] This has been addressed to some degree in the case of preoperative cognitive screening, with work by several groups, including us, demonstrating that brief instruments such as the Mini-Cog and Animal Verbal Fluency can identify patients at risk for poor surgical outcomes. 10,11,14,15 Similarly, there are numerous validated tools to assess frailty, but little consensus about which are best suited to the preoperative setting.…”

Section: What This Article Tells Us That Is Newmentioning

confidence: 99%

“…8,[11][12][13] This has been addressed to some degree in the case of preoperative cognitive screening, with work by several groups, including us, demonstrating that brief instruments such as the Mini-Cog and Animal Verbal Fluency can identify patients at risk for poor surgical outcomes. 10,11,14,15 Similarly, there are numerous validated tools to assess frailty, but little consensus about which are best suited to the preoperative setting. Thus far, investigations of the relationship between frailty and adverse surgical outcomes have largely relied on instruments such as the Frailty Index or the Frailty Phenotype which, are relatively time consuming and labor intensive and therefore unlikely to be widely accepted or adopted in a high throughput preoperative setting.…”

Section: What This Article Tells Us That Is Newmentioning

confidence: 99%

Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery

Susano¹,

Grasfield²,

Friese³

et al. 2020

Anesthesiology

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Background Frailty and cognitive impairment are associated with postoperative delirium, but are rarely assessed preoperatively. The study was designed to test the hypothesis that preoperative screening for frailty or cognitive impairment identifies patients at risk for postoperative delirium (primary outcome). Methods In this prospective cohort study, the authors administered frailty and cognitive screening instruments to 229 patients greater than or equal to 70 yr old presenting for elective spine surgery. Screening for frailty (five-item FRAIL scale [measuring fatigue, resistance, ambulation, illness, and weight loss]) and cognition (Mini-Cog, Animal Verbal Fluency) were performed at the time of the preoperative evaluation. Demographic data, perioperative variables, and postoperative outcomes were gathered. Delirium was the primary outcome detected by either the Confusion Assessment Method, assessed daily from postoperative day 1 to 3 or until discharge, if patient was discharged sooner, or comprehensive chart review. Secondary outcomes were all other-cause complications, discharge not to home, and hospital length of stay. Results The cohort was 75 [73 to 79 yr] years of age, 124 of 219 (57%) were male. Many scored positive for prefrailty (117 of 218; 54%), frailty (53 of 218; 24%), and cognitive impairment (50 to 82 of 219; 23 to 37%). Fifty-five patients (25%) developed delirium postoperatively. On multivariable analysis, frailty (scores 3 to 5 [odds ratio, 6.6; 95% CI, 1.96 to 21.9; P = 0.002]) versus robust (score 0) on the FRAIL scale, lower animal fluency scores (odds ratio, 1.08; 95% CI, 1.01 to 1.51; P = 0.036) for each point decrease in the number of animals named, and more invasive surgical procedures (odds ratio, 2.69; 95% CI, 1.31 to 5.50; P = 0.007) versus less invasive procedures were associated with postoperative delirium. Conclusions Screening for frailty and cognitive impairment preoperatively using the FRAIL scale and the Animal Verbal Fluency test in older elective spine surgery patients identifies those at high risk for the development of postoperative delirium. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Sensitivity and specificity of the animal fluency test for predicting postoperative delirium

Cited by 26 publications

References 17 publications

Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients

Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients

Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study

Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery

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