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Source
Brief title
Health condition
Postoperative Cognitive Dysfunction (POCD)
Sponsors and support
Intervention
Outcome measures
Primary outcome
- Agreement between performance on the TICS, MoCA and NPA and its cognitive domains
o The correlation between the TICS, MoCA and total NPA score and baseline characteristics
o The correlation between the TICS, MoCA and the cognitive domain scores of the NPA and baseline characteristics
o The correlation between TICS and MoCA total scores and cognitive domain scores pre- and approximately one month postoperatively
Secondary outcome
- The validity, sensitivity and specificity of the TICS and MoCA questionnaires compared to the gold standard (NPA) both on baseline and on postoperative change scores from baseline
Background summary
Coming years will see increased aging of the Dutch population, subsequently resulting in more surgery in this group . This is reflected in the recent guideline of the Dutch Society of Anesthesiology (NVA), advising to screen elderly preoperative patients for frailty and cognitive impairment. The incidence of postoperative cognitive dysfunction (POCD) in the elderly is approximately 25% after one week and 10% after three months. However, because of poor characterization of the syndrome and resulting lack of diagnostic criteria, substantial variation exists in reported incidence rates. Nevertheless, POCD is associated with increased length of hospital stay after surgery, subsequent cognitive decline and premature death. To date, extensive and time consuming neuropsychological screening of patients is still the gold standard for diagnosing POCD. In the literature it has been suggested that neuropsychological assessment (NPA) should involve multiple domains. Declines in perception and abstract thinking, learning, memory, attention, executive functioning and language have all been proposed. Most of these tests require face-to-face administration, which is not always feasible, particularly in the follow-up of the elderly. Therefore, a screening tool identifying patients at risk for POCD would be very useful in the preoperative setting. The Telephone Interview for Cognitive Status (TICS), was modeled after the Mini-Mental State Examination (MMSE) and is purported to be a test of global cognitive functioning. The test has the added benefit of being administered over telephone. The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening tool for mild cognitive impairment and has been named as a potentially suitable tool for diagnosing POCD.
In this study, we aim to validate the TICS and MoCA questionnaires against NPT, hoping to find a patient friendly and easy to use screening aid for preoperative evaluation clinics. Thus, aiding shared decision making regarding the appropriate treatment choices for patients.
Study objective
In validating the TICS and MoCA questionnaires against NPT, we hope to find a patient friendly and easy to use screening aid for preoperative evaluation clinics.
Study design
Neurocognitive function tests: In all participating subjects we will administer the TICS and MoCA questionnaire to assess pre- and postoperative cognitive dysfunction. The preoperative screening will, at the latest, be completed one day before surgery. The postoperative questionnaires will be administered between 3-8 weeks postoperatively.
The neuropsychological assessment shall consist of 11 standard verbal and nonverbal tasks that takes between 60 and 90 minutes to complete. NPA will be undertaken both pre- and approximately one month postoperatively.
Inclusion criteria
In order to be eligible to participate in this study, a patient must meet all of the following criteria:
- Elective minor, moderate or major surgery, according to the definition of the European Society of Anesthesiology
- Age ≥65 years
- ASA l - lV
- Fluent in written and spoken Dutch
- Willing and able to undergo neuropsychological assessment, and have the MoCA and TICS administered both pre- and approximately one month postoperatively.
Exclusion criteria
Exclusion criteria:
- Emergency surgery
- Previously diagnosed cognitive dysfunction
- Patients who are unable to understand or fill-in questionnaires in Dutch
Design
Recruitment
IPD sharing statement
Followed up by the following (possibly more current) registration
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
NTR-new | NL7676 |
CCMO | NL69806.018.19 |
OMON | NL-OMON48512 |