一项针对接受择期手术的老年人进行基于电话的虚拟术前认知评估的提议。
A proposal for virtual, telephone-based preoperative cognitive assessment in older adults undergoing elective surgery.
作者信息
Cooper Lisa, Krishnan Sindhu, Javedan Houman, Bader Angela M, Tulabaev Samir
机构信息
Division of Aging, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA.
Department of Anesthesiology, Perioperative Medicine and Pain, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA.
出版信息
Perioper Med (Lond). 2022 Aug 18;11(1):41. doi: 10.1186/s13741-022-00274-z.
OBJECTIVE
To assess the feasibility of administering the MoCA 5-minute test/Telephone (T-MoCA), an abbreviated version of the Montreal Cognitive Assessment to older adults perioperatively DESIGN: A feasibility study including patients aged ≥ 70 years scheduled for surgery from December 2020 to March 2021 SETTING: Preoperative virtual clinic PATIENTS: Patients ≥70 years undergoing major elective surgery INTERVENTION: A study investigator called eligible patients prior to surgery, obtained consent, and completed the preoperative cognitive assessment. Follow-up assessment was completed 1-month postoperatively, and participating clinicians were surveyed at the completion of the study.
MEASUREMENTS
An attention test, T-MoCA, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and Generalized Anxiety Disorder 2-item (GAD-2) MAIN RESULTS: Overall, 37/40 (92.5%) patients completed the pre- and post-operative assessments. The cohort was 50% female, white (97.5%), with a median age of 76 years (interquartile range (IQR) 73-79), and education level was higher than high school in 82.5% of patients. Preoperatively, the median number of medications was 8 (IQR 7-11), 27/40 (67.5%) had medications with anticholinergic effects, and 6/40 (15%) had benzodiazepines. Median completion time of the phone assessment was 10 min (IQR 8.25-12) and 4 min (IQR 3-5) for the T-MoCA with a median T-MoCA score of 13 (IQR 12-14). Most patients (37/40) completed the post-operative assessment, and 6/37 (16.2%) reported they had experienced a change in memory or attention post-operatively. Clinician's survey reported ease and feasibility in performing T-MoCA as a preoperative cognitive evaluation.
CONCLUSION
Preoperative cognitive assessment of older adults using T-MoCA over the phone is easy to perform by clinicians and had a high completion rate by patients. This test is feasible for virtual assessments. Further research is needed to better define validity and correlation with postoperative outcomes.
目的
评估对老年患者围手术期进行蒙特利尔认知评估简版（MoCA）5分钟测试/电话版（T-MoCA）的可行性。
设计
一项可行性研究，纳入2020年12月至2021年3月计划接受手术的≥70岁患者。
地点
术前虚拟诊所。
患者
≥70岁接受重大择期手术的患者。
干预措施
研究调查员在手术前致电符合条件的患者，获得同意，并完成术前认知评估。术后1个月完成随访评估，研究结束时对参与的临床医生进行调查。
测量指标
注意力测试、T-MoCA、日常生活活动能力（ADL）、工具性日常生活活动能力（IADL）以及广泛性焦虑障碍2项量表（GAD-2）。
主要结果
总体而言，37/40（92.5%）的患者完成了术前和术后评估。该队列中女性占50%，白人占97.5%，中位年龄为76岁（四分位间距[IQR]73 - 79），82.5%的患者教育水平高于高中。术前，药物中位数为8种（IQR 7 - 11），27/40（67.5%）服用具有抗胆碱能作用的药物，6/40（15%）服用苯二氮䓬类药物。电话评估的中位完成时间为10分钟（IQR 8.25 - 12），T-MoCA的中位完成时间为4分钟（IQR 3 - 5），T-MoCA中位得分为13分（IQR 12 - 14）。大多数患者（37/40）完成了术后评估，6/37（16.2%）报告术后记忆或注意力有变化。临床医生调查显示，进行T-MoCA作为术前认知评估简便可行。
结论
临床医生通过电话使用T-MoCA对老年患者进行术前认知评估操作简便，患者完成率高。该测试对于虚拟评估可行。需要进一步研究以更好地界定其有效性以及与术后结局的相关性。
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