Department of Anesthesiology, Tsinghua University Yuquan Hospital, Beijing, 100040, People's Republic of China.
Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, People's Republic of China.
Clin Interv Aging. 2023 Sep 14;18:1555-1564. doi: 10.2147/CIA.S410687. eCollection 2023.
A simple, rapid, and effective cognitive screening test appropriate for fast-paced settings with limited resources and staff is essential, especially preoperatively. This study aimed to develop and validate the short versions of Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) for predicting postoperative delirium (POD) in patients with Parkinson's disease (PD) who were scheduled for surgery.
The current study was a secondary analysis of data collected from 128 inpatients scheduled for deep brain stimulation of the subthalamic nuclei (STN-DBS) lasting >60 min, at Tsinghua University Yuquan Hospital, China. Preoperative cognitive screening was performed during the preoperative visit using the MMSE and MoCA. The optimal MMSE and MoCA cut-off scores for detecting PD-MCI was 27 and 23 respectively. The POD was assessed twice a day on the first postoperative day until discharge by the confusion assessment method. The backward conditional logistic regression analysis was used to organize the reduced versions of the MMSE or MoCA. Also, the areas under the receiver operating characteristic curves (AUCs) were examined using the DeLong test.
125/128 PD patients were included in the analysis, and 27 (21.6%) developed POD. The MMSE reduced version (orientation to time, attention and calculation, and comprehension) demonstrated performance similar to the original MMSE in predicting POD (=0.820, =0.412). The AUC of the original MoCA and the short MoCA (visuospatial and executive attention and orientation) were 0.808 and 0.826, respectively. There was no significantly difference in the AUC values between the tests (=0.561, =0.575).
Our simplified MMSE and MoCA could be efficiently used to identify patients at risk for POD. Also, short cognitive tests could be considered while predicting POD in fast-paced preoperative settings with limited resources and staff.
对于资源和人员有限、节奏快的环境，需要一种简单、快速且有效的认知筛查测试，尤其在术前。本研究旨在开发并验证简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA）的简短版本，以预测拟行手术的帕金森病（PD）患者术后谵妄（POD）。
本研究是对在中国清华大学玉泉医院接受深部脑刺激（STN-DBS）治疗的 128 例住院患者数据的二次分析。在术前访视期间使用 MMSE 和 MoCA 进行术前认知筛查。用于检测 PD-MCI 的 MMSE 和 MoCA 的最佳截断值分别为 27 和 23。在术后第一天，每天两次使用意识模糊评估法（CAM）评估 POD，直到出院。采用后向条件逻辑回归分析对 MMSE 或 MoCA 的简化版本进行整理。还使用 DeLong 检验检查受试者工作特征曲线下面积（AUC）。
128 例 PD 患者中有 125 例纳入分析，其中 27 例（21.6%）发生 POD。简化版 MMSE（定向力、注意力和计算、理解）在预测 POD 方面与原始 MMSE 表现相似（=0.820，=0.412）。原始 MoCA 和短 MoCA（视空间和执行注意力及定向力）的 AUC 分别为 0.808 和 0.826。两种检测方法的 AUC 值无显著差异（=0.561，=0.575）。
我们简化的 MMSE 和 MoCA 可有效地用于识别发生 POD 的高风险患者。在资源和人员有限、节奏快的术前环境中预测 POD 时，也可以考虑使用简短的认知测试。
