Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada.
Biostatistics Department, University Health Network, Toronto, ON, Canada.
J Clin Anesth. 2024 Oct;97:111557. doi: 10.1016/j.jclinane.2024.111557. Epub 2024 Jul 23.
To determine the prevalence of suspected cognitive impairment using the Centers for Disease Control and Prevention (CDC) cognitive question, Ascertain Dementia Eight-item Questionnaire (AD8), Modified Telephone Interview for Cognitive Status (TICS-M), and Telephone Montreal Cognitive Assessment (T-MoCA), the agreement between each tool beyond chance, and the risk factors associated with a positive screen.
Multicenter prospective study.
Remote preoperative assessments.
307 non-cardiac surgical patients aged ≥65 years.
Prevalence, Cohen's kappa (κ).
The T-MoCA detected the highest prevalence of suspected cognitive impairment (28%), followed by the AD8 (17%), CDC cognitive question (9%), and TICS-M (6%). The four screening tools showed poor agreement beyond chance with one another, with the CDC cognitive question and AD8 approaching the threshold for weak agreement (κ = 0.39). Depression was associated with screening positive on the CDC cognitive question (OR: 2.81; 95% CI: 1.04, 7.68). Obstructive sleep apnea (OSA) (OR: 3.10; 95% CI: 1.26, 7.71) and functional disability (OR: 3.74; 95% CI: 1.34, 11.11) were associated with a positive AD8 screen. Older age (OR: 1.56; 95% CI: 1.01, 2.41), male sex (OR: 3.08; 95% CI: 1.09, 9.40), and higher pain level (OR: 1.21; 95% CI: 1.01, 1.47) were associated with a positive TICS-M screen. Similarly, older age (OR: 1.33; 95% CI: 1.03, 1.73), male sex (OR: 2.02; 95% CI: 1.09, 3.83), and higher pain level (OR: 1.15; 95% CI: 1.02, 1.30) were associated with a positive T-MoCA screen.
The CDC cognitive question, AD8, TICS-M, and T-MoCA were easily implemented during preoperative assessment among older surgical patients. OSA, functional disability, and depression were associated with complaints on the CDC cognitive question and AD8. Older age, male sex, and higher pain level were associated with screening positive on the TICS-M and T-MoCA. Early remote cognitive screening may enhance risk stratification of vulnerable patients.
使用疾病控制与预防中心（CDC）认知问题、阿兹海默症 8 项问卷（AD8）、改良电话认知状态测试（TICS-M）和电话蒙特利尔认知评估（T-MoCA）来确定疑似认知障碍的患病率，确定各工具间的一致性是否超出偶然，以及与阳性筛查相关的风险因素。
多中心前瞻性研究。
远程术前评估。
307 名年龄≥65 岁的非心脏手术患者。
患病率、Cohen's kappa（κ）。
T-MoCA 检测出的疑似认知障碍患病率最高（28%），其次是 AD8（17%）、CDC 认知问题（9%）和 TICS-M（6%）。这四种筛查工具之间的一致性均低于偶然，CDC 认知问题和 AD8 接近弱一致性的阈值（κ=0.39）。抑郁与 CDC 认知问题筛查阳性有关（OR：2.81；95%CI：1.04，7.68）。阻塞性睡眠呼吸暂停（OSA）（OR：3.10；95%CI：1.26，7.71）和功能障碍（OR：3.74；95%CI：1.34，11.11）与 AD8 筛查阳性有关。年龄较大（OR：1.56；95%CI：1.01，2.41）、男性（OR：3.08；95%CI：1.09，9.40）和较高的疼痛水平（OR：1.21；95%CI：1.01，1.47）与 TICS-M 筛查阳性有关。同样，年龄较大（OR：1.33；95%CI：1.03，1.73）、男性（OR：2.02；95%CI：1.09，3.83）和较高的疼痛水平（OR：1.15；95%CI：1.02，1.30）与 T-MoCA 筛查阳性有关。
CDC 认知问题、AD8、TICS-M 和 T-MoCA 易于在老年手术患者的术前评估中实施。OSA、功能障碍和抑郁与 CDC 认知问题和 AD8 的抱怨有关。年龄较大、男性和较高的疼痛水平与 TICS-M 和 T-MoCA 的阳性筛查有关。早期远程认知筛查可能会增强对脆弱患者的风险分层。
