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Factors affecting short-term functional gain following total knee arthroplasty in patients aged from 75 years at a postacute rehabilitation setting. Int J Rehabil Res 2022; 45:260-266. [PMID: 35777929 DOI: 10.1097/mrr.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The intensive rehabilitation of older patients after total knee arthroplasty (TKA) is vital for short-term improvement in mobility and daily living activities. We aimed to investigate the effectiveness of multidisciplinary rehabilitation and assess the early postoperative predictors that are associated with functional gain in TKA patients aged from 75 years in a postacute care setting. This study included 190 patients following primary TKA who were admitted at the postacute rehabilitation hospital. The main outcome measures were the motor component of functional independence measure (M-FIM), M-FIM effectiveness, numerical rating scale, knee extension strength and range of motion, 10-m walk test, Berg balance scale (BBS), and mini-mental state examination (MMSE). The functional gain between patient age groups of ≥75 (n = 105) and <75 (n = 85) years were compared. Although patients aged ≥75 years showed lower improvement in BBS score compared with <75 years, the M-FIM gains and other physical functions were similar in both age groups. In multivariate analysis, the results for M-FIM at admission (β: -0.703; P = 0.001), BBS (β: 0.342; P = 0.032) and MMSE (β: 0.446; P = 0.021) were independently associated with functional gain in the patients following TKA aged ≥75 years. Multidisciplinary inpatient rehabilitation was beneficial for basic functional gain except for improvement in balance ability in patients after TKA aged ≥75 years. Functional level, balance ability and cognitive status in the early postoperative period can be useful predictors for short-term functional gain in the postacute care phase.
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te Pas M, Olde Rikkert M, Bouwman A, Kessels R, Buise M. Screening for Mild Cognitive Impairment in the Preoperative Setting: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10061112. [PMID: 35742163 PMCID: PMC9223065 DOI: 10.3390/healthcare10061112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/26/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022] Open
Abstract
Cognitive impairment predisposes patients to the development of delirium and postoperative cognitive dysfunction. In particular, in older patients, the adverse sequelae of cognitive decline in the perioperative period may contribute to adverse outcomes after surgical procedures. Subtle signs of cognitive impairment are often not previously diagnosed. Therefore, the aim of this review is to describe the available cognitive screeners suitable for preoperative screening and their psychometric properties for identifying mild cognitive impairment, as preoperative workup may improve perioperative care for patients at risk for postoperative cognitive dysfunction. Electronic systematic and snowball searches of PubMed, PsycInfo, ClinicalKey, and ScienceDirect were conducted for the period 2015–2020. Major inclusion criteria for articles included those that discussed a screener that included the cognitive domain ‘memory’, that had a duration time of less than 15 min, and that reported sensitivity and specificity to detect mild cognitive impairment. Studies about informant-based screeners were excluded. We provided an overview of the characteristics of the cognitive screener, such as interrater and test-retest reliability correlations, sensitivity and specificity for mild cognitive impairment and cognitive impairment, and duration of the screener and cutoff points. Of the 4775 identified titles, 3222 were excluded from further analysis because they were published prior to 2015. One thousand four hundred and forty-eight titles did not fulfill the inclusion criteria. All abstracts of 52 studies on 45 screeners were examined of which 10 met the inclusion criteria. For these 10 screeners, a further snowball search was performed to obtain related studies, resulting in 20 articles. Screeners included in this review were the Mini-Cog, MoCA, O3DY, AD8, SAGE, SLUMS, TICS(-M), QMCI, MMSE2, and Mini-ACE. The sensitivity and specificity range to detect MCI in an older population is the highest for the MoCA, with a sensitivity range of 81–93% and a specificity range of 74–89%. The MoCA, with the highest combination of sensitivity and specificity, is a feasible and valid routine screening of pre-surgical cognitive function. This warrants further implementation and validation studies in surgical pathways with a large proportion of older patients.
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Affiliation(s)
- Mariska te Pas
- Department of Anesthesiology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (A.B.); (M.B.)
- Correspondence: ; Tel.: +31-627624857
| | - Marcel Olde Rikkert
- Radboud University Medical Center, Department of Geriatric Medicine, 6500 GL Nijmegen, The Netherlands;
| | - Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (A.B.); (M.B.)
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
| | - Roy Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 XZ Nijmegen, The Netherlands;
- Department of Medical Psychology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, 5803 AC Venray, The Netherlands
| | - Marc Buise
- Department of Anesthesiology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (A.B.); (M.B.)
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Post-Operative Cognitive Impairment: A Cognitive Epidemiology Perspective. J Intell 2022; 10:jintelligence10010018. [PMID: 35324574 PMCID: PMC8949407 DOI: 10.3390/jintelligence10010018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
Cognitive epidemiology investigates cognitive predictors of health and disease outcomes. Post-operative cognitive impairment is a common complication of surgery but has been neglected as a health outcome in cognitive epidemiology research. This is despite the fact that knowledge of cognitive predictors of post-operative cognitive impairment can be utilized for risk stratification, informed decision-making (in elective surgery), and personalized care of patients during the postoperative period. In this narrative review, the current literature on cognitive predictors of post-operative cognitive impairment and gaps therein are summarized.
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Postoperative Delirium and Postoperative Cognitive Dysfunction in Patients with Elective Hip or Knee Arthroplasty: A Narrative Review of the Literature. Life (Basel) 2022; 12:life12020314. [PMID: 35207601 PMCID: PMC8878498 DOI: 10.3390/life12020314] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/06/2022] [Accepted: 02/18/2022] [Indexed: 12/31/2022] Open
Abstract
Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common complications following total knee arthroplasty (TKA) and total hip arthroplasty (THA), affecting the length of hospital stay and increasing medical complications. Although many papers have been published on both conditions in this setting, no reviews have currently been written. Thus, the purpose of our study is to summarize the current literature and provide information about POD and POCD following elective THA or TKA. Our literature search was conducted in the electronic databases PubMed and the Cochrane library. We found that POD is a common complication following elective THA or TKA, with a median incidence of 14.8%. Major risk factors include older age, cognitive impairment, dementia, preoperative (pre-op) comorbidities, substance abuse, and surgery for fracture. Diagnosis can be achieved using tools such as the confusion assessment method (CAM), which is sensitive, specific, reliable, and easy to use, for the identification of POD. Treatment consists of risk stratification and the implementation of a multiple component prevention protocol. POCD has a median incidence of 19.3% at 1 week, and 10% at 3 months. Risk factors include older age, high BMI, and cognitive impairment. Treatment consists of reversing risk factors and implementing protocols in order to preserve physiological stability. POD and POCD are common and preventable complications following TKA and THA. Risk stratification and specific interventions can lower the incidence of both syndromes. Every physician involved in the care of such patients should be informed on every aspect of these conditions in order to provide the best care for their patients.
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Khan G, Mirza N, Waheed W. Developing guidelines for the translation and cultural adaptation of the Montreal Cognitive Assessment: scoping review and qualitative synthesis. BJPsych Open 2022; 8:e21. [PMID: 34991771 PMCID: PMC8811786 DOI: 10.1192/bjo.2021.1067] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Ethnic minorities in countries such as the UK are at increased risk of dementia or minor cognitive impairment. Despite this, cognitive tests used to provide a timely diagnosis for these conditions demonstrate performance bias in these groups, because of cultural context. They require adaptation that accounts for language and culture beyond translation. The Montreal Cognitive Assessment (MoCA) is one such test that has been adapted for multiple cultures. AIMS We followed previously used methodology for culturally adapting cognitive tests to develop guidelines for translating and culturally adapting the MoCA. METHOD We conducted a scoping review of publications on different versions of the MoCA. We extracted their translation and cultural adaptation procedures. We also distributed questionnaires to adaptors of the MoCA for data on the procedures they undertook to culturally adapt their respective versions. RESULTS Our scoping review found 52 publications and highlighted seven steps for translating the MoCA. We received 17 responses from adaptors on their cultural adaptation procedures, with rationale justifying them. We combined data from the scoping review and the adaptors' feedback to form the guidelines that state how each question of the MoCA has been previously adapted for different cultural contexts and the reasoning behind it. CONCLUSIONS This paper details our development of cultural adaptation guidelines for the MoCA that future adaptors can use to adapt the MoCA for their own languages or cultures. It also replicates methods previously used and demonstrates how these methods can be used for the cultural adaptation of other cognitive tests.
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Affiliation(s)
- Ghazn Khan
- Centre for Primary Care and Health Services Research, The University of Manchester, UK
| | - Nadine Mirza
- Centre for Primary Care and Health Services Research, The University of Manchester, UK
| | - Waquas Waheed
- Centre for Primary Care and Health Services Research, The University of Manchester, UK
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Seitz DP, Chan CC, Newton HT, Gill SS, Herrmann N, Smailagic N, Nikolaou V, Fage BA. Mini-Cog for the detection of dementia within a primary care setting. Cochrane Database Syst Rev 2021; 7:CD011415. [PMID: 34261197 PMCID: PMC8406662 DOI: 10.1002/14651858.cd011415.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Alzheimer's disease and other forms of dementia are becoming increasingly common with the aging of most populations. The majority of individuals with dementia will first present for care and assessment in primary care settings. There is a need for brief dementia screening instruments that can accurately detect dementia in primary care settings. The Mini-Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings. OBJECTIVES To determine the accuracy of the Mini-Cog for detecting dementia in a primary care setting. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Register of Diagnostic Test Accuracy Studies, MEDLINE, Embase and four other databases, initially to September 2012. Since then, four updates to the search were performed using the same search methods, and the most recent was January 2017. We used citation tracking (using the databases' 'related articles' feature, where available) as an additional search method and contacted authors of eligible studies for unpublished data. SELECTION CRITERIA We only included studies that evaluated the Mini-Cog as an index test for the diagnosis of Alzheimer's disease dementia or related forms of dementia when compared to a reference standard using validated criteria for dementia. We only included studies that were conducted in primary care populations. DATA COLLECTION AND ANALYSIS We extracted and described information on the characteristics of the study participants and study setting. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria we evaluated the quality of studies, and we assessed risk of bias and applicability of each study for each domain in QUADAS-2. Two review authors independently extracted information on the true positives, true negatives, false positives, and false negatives and entered the data into Review Manager 5 (RevMan 5). We then used RevMan 5 to determine the sensitivity, specificity, and 95% confidence intervals. We summarized the sensitivity and specificity of the Mini-Cog in the individual studies in forest plots and also plotted them in a receiver operating characteristic plot. We also created a 'Risk of bias' and applicability concerns graph to summarize information related to the quality of included studies. MAIN RESULTS There were a total of four studies that met our inclusion criteria, including a total of 1517 total participants. The sensitivity of the Mini-Cog varied between 0.76 to 1.00 in studies while the specificity varied between 0.27 to 0.85. The included studies displayed significant heterogeneity in both methodologies and clinical populations, which did not allow for a meta-analysis to be completed. Only one study (Holsinger 2012) was found to be at low risk of bias on all methodological domains. The results of this study reported that the sensitivity of the Mini-Cog was 0.76 and the specificity was 0.73. We found the quality of all other included studies to be low due to a high risk of bias with methodological limitations primarily in their selection of participants. AUTHORS' CONCLUSIONS There is a limited number of studies evaluating the accuracy of the Mini-Cog for the diagnosis of dementia in primary care settings. Given the small number of studies, the wide range in estimates of the accuracy of the Mini-Cog, and methodological limitations identified in most of the studies, at the present time there is insufficient evidence to recommend that the Mini-Cog be used as a screening test for dementia in primary care. Further studies are required to determine the accuracy of Mini-Cog in primary care and whether this tool has sufficient diagnostic test accuracy to be useful as a screening test in this setting.
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Affiliation(s)
- Dallas P Seitz
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Calvin Ch Chan
- School of Medicine, Queen's University, Kingston, Canada
| | - Hailey T Newton
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Sudeep S Gill
- Department of Medicine, Queen's University, Kingston, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Nadja Smailagic
- Institute of Public Health, University of Cambridge , Cambridge, UK
| | | | - Bruce A Fage
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Krishnan S, Brovman EY, Urman RD. Preoperative Cognitive Impairment as a Perioperative Risk Factor in Patients Undergoing Total Knee Arthroplasty. Geriatr Orthop Surg Rehabil 2021; 12:21514593211004533. [PMID: 35186420 PMCID: PMC8848037 DOI: 10.1177/21514593211004533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/02/2021] [Indexed: 12/21/2022] Open
Abstract
Background: The study assessed whether pre-existing cognitive impairment (CI) prior to elective total knee arthroplasty (TKA) is associated with worse postoperative outcomes such as delirium, in-hospital medical complications, 30-day mortality, hospital length of stay and non-home discharge. Methods: A retrospective database analysis from the NSQIP Geriatric Surgery Pilot Project was used. There was an initial cohort of 6350 patients undergoing elective TKA, 104 patients with CI were propensity score matched to 104 patients without CI. Results: Analysis demonstrated a significantly increased incidence of post-operative delirium (POD) in the cohort with pre-op CI (p = < .001), a worsened functional status (p = < .001) and increased nonhome discharge postoperatively compared to the group without CI (p = 0.029). Other post-operative outcomes included 30-day mortality of 0% in both groups, and low rate of complications such as infection (2.88% vs 0.96%), pneumonia (1.92% vs 0%), failure to wean (0.96% vs 0%), and reintubation (0.96% vs 0%). Some other differences between the CI group and non-CI group, although not statistically significant, included increased rate of transfusion (10.58% vs 6.73%), and sepsis (1.92% vs 0%). The length of stay was increased in the non-CI group (4.28% vs 2.32%, p = 0.122). Conclusion: CI in patients undergoing TKA is associated with an increased risk of POD, worsened postoperative functional status, and discharge to non-home facility.
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Affiliation(s)
- Sindhu Krishnan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ethan Y. Brovman
- Center for Perioperative Research, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Anesthesiology and Perioperative Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Richard D. Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Center for Perioperative Research, Brigham and Women’s Hospital, Boston, MA, USA
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Lee JW, Im WY, Song SY, Choi JY, Kim SJ. Analysis of early failure rate and its risk factor with 2157 total ankle replacements. Sci Rep 2021; 11:1901. [PMID: 33479348 PMCID: PMC7820457 DOI: 10.1038/s41598-021-81576-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 01/06/2021] [Indexed: 02/03/2023] Open
Abstract
The failure rate of TAA is still higher than that of other joint replacement procedures. This study aimed to calculate the early failure rate and identify associated patient factors. Data from the Korean Health Insurance Review and Assessment Service database from 2009 to 2017 were collected. We evaluated patients who had TAA as a primary surgical procedure. Early failure was defined as conversion to revision TAA or arthrodesis after primary TAA within five years. Patients with early failure after primary TAA were designated as the "Failure group". Patients without early failure and who were followed up unremarkably for at least five years after primary TAA were designated as the "No failure group". Overall, 2157 TAA participants were included. During the study period, 197 patients developed failure within five years postoperatively, for an overall failure rate of 9.1%. Significant risk factors for early failure were history of chronic pulmonary disease, diabetes, peripheral vascular disease, hyperlipidemia, dementia, and alcohol abuse. A significant increase of odds ratio was found in patients with a history of dementia, chronic pulmonary disease, and diabetes. Surgical indications and preoperative patient counseling should consider these factors.
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Affiliation(s)
- Jung Woo Lee
- Department of Orthopaedic Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, 20, Ilsan-ro, Wonju-si, Gangwon-do, 26426, Republic of Korea
| | - Woo-Young Im
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea
| | - Si Young Song
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea
| | - Jae-Young Choi
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, Republic of Korea.,SKKU Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, Suwon-si, Republic of Korea
| | - Sung Jae Kim
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea.
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9
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Grover S, Mehra A, Chakrabarti S, Sahoo S, Avasthi A. Evaluation of association of impairment of attention with other symptoms of delirium. JOURNAL OF MENTAL HEALTH AND HUMAN BEHAVIOUR 2021. [DOI: 10.4103/jmhhb.jmhhb_44_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Chen X, Wen H, Wang J, Yi Y, Wu J, Liao X. Conversion between Mini-Mental State Examination and Montreal Cognitive Assessment scores in older adults undergoing selective surgery using Rasch analysis. J Adv Nurs 2020; 77:729-741. [PMID: 33249626 DOI: 10.1111/jan.14638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/31/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022]
Abstract
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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Affiliation(s)
- Xiaoying Chen
- Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Huangliang Wen
- Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Jinni Wang
- Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Yayan Yi
- Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Jialan Wu
- Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaoyan Liao
- Zengcheng Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China
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11
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Hasan TF, Kelley RE, Cornett EM, Urman RD, Kaye AD. Cognitive impairment assessment and interventions to optimize surgical patient outcomes. Best Pract Res Clin Anaesthesiol 2020; 34:225-253. [PMID: 32711831 DOI: 10.1016/j.bpa.2020.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/20/2020] [Indexed: 12/22/2022]
Abstract
For elderly patients undergoing elective surgical procedures, preoperative evaluation of cognition is often overlooked. Patients may experience postoperative delirium (POD) and postoperative cognitive decline (POCD), especially those with certain risk factors, including advanced age. Preoperative cognitive impairment is a leading risk factor for both POD and POCD, and studies have noted that identifying these deficiencies is critical during the preoperative period so that appropriate preventive strategies can be implemented. Comprehensive geriatric assessment is a useful approach which evaluates a patient's medical, psycho-social, and functional domains objectively. Various screening tools are available for preoperatively identifying patients with cognitive impairment. The Enhanced Recovery After Surgery (ERAS) protocols have been discussed in the context of prehabilitation as an effort to optimize a patient's physical status prior to surgery and decrease the risk of POD and POCD. Evidence-based protocols are warranted to standardize care in efforts to effectively meet the needs of these patients.
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Affiliation(s)
- Tasneem F Hasan
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Roger E Kelley
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, Massachussetts, 02115, USA.
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
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12
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van der Hoek MD, Nieuwenhuizen A, Keijer J, Ashford JW. The MemTrax Test Compared to the Montreal Cognitive Assessment Estimation of Mild Cognitive Impairment. J Alzheimers Dis 2020; 67:1045-1054. [PMID: 30776011 PMCID: PMC6398548 DOI: 10.3233/jad-181003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cognitive impairment is a leading cause of dysfunction in the elderly. When mild cognitive impairment (MCI) occurs in elderly, it is frequently a prodromal condition to dementia. The Montreal Cognitive Assessment (MoCA) is a commonly used tool to screen for MCI. However, this test requires a face-to-face administration and is composed of an assortment of questions whose responses are added together by the rater to provide a score whose precise meaning has been controversial. This study was designed to evaluate the performance of a computerized memory test (MemTrax), which is an adaptation of a continuous recognition task, with respect to the MoCA. Two outcome measures are generated from the MemTrax test: MemTraxspeed and MemTraxcorrect. Subjects were administered the MoCA and the MemTrax test. Based on the results of the MoCA, subjects were divided in two groups of cognitive status: normal cognition (n = 45) and MCI (n = 37). Mean MemTrax scores were significantly lower in the MCI than in the normal cognition group. All MemTrax outcome variables were positively associated with the MoCA. Two methods, computing the average MTX score and linear regression were used to estimate the cutoff values of the MemTrax test to detect MCI. These methods showed that for the outcome MemTraxspeed a score below the range of 0.87 – 91 s-1 is an indication of MCI, and for the outcome MemTraxcorrect a score below the range of 85 – 90% is an indication for MCI.
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Affiliation(s)
- Marjanne D van der Hoek
- Applied Research Centre Food and Dairy, Van Hall Larenstein University of Applied Sciences, Leeuwarden, the Netherlands.,Human and Animal Physiology, Wageningen University, Wageningen, the Netherlands
| | - Arie Nieuwenhuizen
- Human and Animal Physiology, Wageningen University, Wageningen, the Netherlands
| | - Jaap Keijer
- Human and Animal Physiology, Wageningen University, Wageningen, the Netherlands
| | - J Wesson Ashford
- War Related Illness and Injury Study Center, VA Palo Alto HCS, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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13
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Zakharova‐Luneva E, Cooke DM, Okano S, Hurst C, Geffen S, Eagles R. The relationship between cognition and functional outcomes in rehabilitation: FIMCog vs. MoCA. Geriatr Gerontol Int 2020; 20:336-342. [DOI: 10.1111/ggi.13884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/14/2019] [Accepted: 01/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Deirdre M Cooke
- Rehabilitation UnitMater Private Hospital South Brisbane Queensland Australia
| | - Satomi Okano
- Statistics UnitQIMR Berghofer Medical Research Institute Brisbane Queensland Australia
| | - Cameron Hurst
- Statistics UnitQIMR Berghofer Medical Research Institute Brisbane Queensland Australia
| | - Saul Geffen
- Rehabilitation UnitMater Private Hospital South Brisbane Queensland Australia
| | - Roslyn Eagles
- Rehabilitation UnitMater Private Hospital South Brisbane Queensland Australia
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14
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Cognitive impairment and postoperative outcomes in patients undergoing primary total hip arthroplasty: A systematic review. J Clin Anesth 2019; 56:65-76. [DOI: 10.1016/j.jclinane.2019.01.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/12/2019] [Accepted: 01/18/2019] [Indexed: 12/11/2022]
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Ablett AD, McCarthy K, Carter B, Pearce L, Stechman M, Moug S, Hewitt J, Myint PK. Cognitive impairment is associated with mortality in older adults in the emergency surgical setting: Findings from the Older Persons Surgical Outcomes Collaboration (OPSOC): A prospective cohort study. Surgery 2019; 165:978-984. [DOI: 10.1016/j.surg.2018.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/30/2018] [Accepted: 10/13/2018] [Indexed: 12/29/2022]
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Luan Erfe BM, Boehme J, Erfe JM, Brovman EY, Bader AM, Urman RD. Postoperative Outcomes in Primary Total Knee Arthroplasty Patients With Preexisting Cognitive Impairment: A Systematic Review. Geriatr Orthop Surg Rehabil 2018; 9:2151459318816482. [PMID: 30622833 PMCID: PMC6304705 DOI: 10.1177/2151459318816482] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/08/2018] [Accepted: 11/05/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To evaluate the body of evidence on the predictive value of preoperative cognitive impairment on in-hospital, short-term, and midterm postoperative outcomes for elderly patients undergoing total knee arthroplasty (TKA). SIGNIFICANCE With an aging population, an increasing percentage of the U.S. patient population will be living with cognitive impairment. There is currently no systematic review that assesses postoperative outcomes of patients with mild cognitive impairment (MCI) or preexisting diagnosis of dementia while undergoing elective primary TKA. RESULTS A database search between January 1, 1997, and November 1, 2017 in EMBASE, MEDLINE, and PubMed was conducted to identify articles that compared postoperative outcomes after TKA between patients aged 60 years with and without cognitive impairment. Cognitive impairment included preexisting diagnosis of dementia or MCI identified during preoperative assessment. Eligible articles were selected using dual reviewer and third-party arbitrator. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A total of 6163 abstracts were screened. Only 11 full text articles met inclusion criteria, including 1 case-control, 5 prospective cohort, and 5 retrospective cohort studies. Two studies were of poor quality. Overall, there is moderate strength of evidence for increased risk of postoperative delirium, increased length of stay, and discharge to health-care facility among patients with preoperative MCI or preexisting dementia. The body of evidence is weak for other outcomes of interest including mortality, functionality and complications while in-hospital and in the short- and midterm. CONCLUSION This review highlights the need for additional good quality studies to provide more information about MCI and dementia as risk factors in primary TKA.
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Affiliation(s)
| | - Jacqueline Boehme
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | | | - Ethan Y. Brovman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Angela M. Bader
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Richard D. Urman
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
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Berger M, Schenning KJ, Brown CH, Deiner SG, Whittington RA, Eckenhoff RG. Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group. Anesth Analg 2018; 127:1406-1413. [PMID: 30303868 PMCID: PMC6309612 DOI: 10.1213/ane.0000000000003841] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
As part of the American Society of Anesthesiology Brain Health Initiative goal of improving perioperative brain health for older patients, over 30 experts met at the fifth International Perioperative Neurotoxicity Workshop in San Francisco, CA, in May 2016, to discuss best practices for optimizing perioperative brain health in older adults (ie, >65 years of age). The objective of this workshop was to discuss and develop consensus solutions to improve patient management and outcomes and to discuss what older adults should be told (and by whom) about postoperative brain health risks. Thus, the workshop was provider and patient oriented as well as solution focused rather than etiology focused. For those areas in which we determined that there were limited evidence-based recommendations, we identified knowledge gaps and the types of scientific knowledge and investigations needed to direct future best practice. Because concerns about perioperative neurocognitive injury in pediatric patients are already being addressed by the SmartTots initiative, our workshop discussion (and thus this article) focuses specifically on perioperative cognition in older adults. The 2 main perioperative cognitive disorders that have been studied to date are postoperative delirium and cognitive dysfunction. Postoperative delirium is a syndrome of fluctuating changes in attention and level of consciousness that occurs in 20%-40% of patients >60 years of age after major surgery and inpatient hospitalization. Many older surgical patients also develop postoperative cognitive deficits that typically last for weeks to months, thus referred to as postoperative cognitive dysfunction. Because of the heterogeneity of different tools and thresholds used to assess and define these disorders at varying points in time after anesthesia and surgery, a recent article has proposed a new recommended nomenclature for these perioperative neurocognitive disorders. Our discussion about this topic was organized around 4 key issues: preprocedure consent, preoperative cognitive assessment, intraoperative management, and postoperative follow-up. These 4 issues also form the structure of this document. Multiple viewpoints were presented by participants and discussed at this in-person meeting, and the overall group consensus from these discussions was then drafted by a smaller writing group (the 6 primary authors of this article) into this manuscript. Of course, further studies have appeared since the workshop, which the writing group has incorporated where appropriate. All participants from this in-person meeting then had the opportunity to review, edit, and approve this final manuscript; 1 participant did not approve the final manuscript and asked for his/her name to be removed.
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Affiliation(s)
- Miles Berger
- Anesthesiology Department, Duke University Medical Center, Durham, North Carolina
| | - Katie J. Schenning
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Charles H. Brown
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stacie G. Deiner
- Anesthesiology Department, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert A. Whittington
- Department of Anesthesiology, Columbia University Medical Center, New York, New York
| | - Roderic G. Eckenhoff
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Seitz DP, Chan CCH, Newton HT, Gill SS, Herrmann N, Smailagic N, Nikolaou V, Fage BA. Mini-Cog for the diagnosis of Alzheimer's disease dementia and other dementias within a primary care setting. Cochrane Database Syst Rev 2018; 2:CD011415. [PMID: 29470861 PMCID: PMC6491332 DOI: 10.1002/14651858.cd011415.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Alzheimer's disease and other forms of dementia are becoming increasingly common with the aging of most populations. The majority of individuals with dementia will first present for care and assessment in primary care settings. There is a need for brief dementia screening instruments that can accurately diagnose dementia in primary care settings. The Mini-Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings. OBJECTIVES To determine the diagnostic accuracy of the Mini-Cog for diagnosing Alzheimer's disease dementia and related dementias in a primary care setting. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Register of Diagnostic Test Accuracy Studies, MEDLINE, Embase and four other databases, initially to September 2012. Since then, four updates to the search were performed using the same search methods, and the most recent was January 2017. We used citation tracking (using the databases' 'related articles' feature, where available) as an additional search method and contacted authors of eligible studies for unpublished data. SELECTION CRITERIA We only included studies that evaluated the Mini-Cog as an index test for the diagnosis of Alzheimer's disease dementia or related forms of dementia when compared to a reference standard using validated criteria for dementia. We only included studies that were conducted in primary care populations. DATA COLLECTION AND ANALYSIS We extracted and described information on the characteristics of the study participants and study setting. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria we evaluated the quality of studies, and we assessed risk of bias and applicability of each study for each domain in QUADAS-2. Two review authors independently extracted information on the true positives, true negatives, false positives, and false negatives and entered the data into Review Manager 5 (RevMan 5). We then used RevMan 5 to determine the sensitivity, specificity, and 95% confidence intervals. We summarized the sensitivity and specificity of the Mini-Cog in the individual studies in forest plots and also plotted them in a receiver operating characteristic plot. We also created a 'Risk of bias' and applicability concerns graph to summarize information related to the quality of included studies. MAIN RESULTS There were a total of four studies that met our inclusion criteria, including a total of 1517 total participants. The sensitivity of the Mini-Cog varied between 0.76 to 1.00 in studies while the specificity varied between 0.27 to 0.85. The included studies displayed significant heterogeneity in both methodologies and clinical populations, which did not allow for a meta-analysis to be completed. Only one study (Holsinger 2012) was found to be at low risk of bias on all methodological domains. The results of this study reported that the sensitivity of the Mini-Cog was 0.76 and the specificity was 0.73. We found the quality of all other included studies to be low due to a high risk of bias with methodological limitations primarily in their selection of participants. AUTHORS' CONCLUSIONS There is a limited number of studies evaluating the accuracy of the Mini-Cog for the diagnosis of dementia in primary care settings. Given the small number of studies, the wide range in estimates of the accuracy of the Mini-Cog, and methodological limitations identified in most of the studies, at the present time there is insufficient evidence to recommend that the Mini-Cog be used as a screening test for dementia in primary care. Further studies are required to determine the accuracy of Mini-Cog in primary care and whether this tool has sufficient diagnostic test accuracy to be useful as a screening test in this setting.
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Affiliation(s)
- Dallas P Seitz
- Queen's UniversityDepartment of Psychiatry752 King Street WestKingstonONCanadaK7L 4X3
| | - Calvin CH Chan
- Queen's UniversitySchool of Medicine49 King Street EastKingstonONCanadaK7L 2Z5
| | - Hailey T Newton
- Queen's UniversityDepartment of Psychiatry752 King Street WestKingstonONCanadaK7L 4X3
| | - Sudeep S Gill
- Queen's UniversityDepartment of MedicineSt. Mary's of the Lake Hospital340 Union StreetKingstonONCanadaK7L 5A2
| | - Nathan Herrmann
- Sunnybrook Research InstituteHurvitz Brain Sciences Research Program2075 Bayview AvenueRoom FG‐05TorontoONCanadaM4N 3M5
| | - Nadja Smailagic
- University of CambridgeInstitute of Public HealthForvie SiteRobinson WayCambridgeUKCB2 0SR
| | | | - Bruce A Fage
- University of TorontoDepartment of PsychiatryTorontoONCanada
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