Neuro Anesthesia Unit, Rambam Healthcare Campus, Haifa, Israel.
Applied Neurophysiology Laboratory, Rambam Healthcare Campus, Haifa, Israel.
Brain Behav. 2024 Aug;14(8):e3649. doi: 10.1002/brb3.3649.
Cognitive assessment is based on performance in different tests. However, this performance might be hindered by lack of effective effort on the one hand, and by too much stress on the other hand. Despite their known impact, there are currently no effective tools for measuring cognitive effort or stress effect during cognitive assessment. We developed real-time electrophysiological markers for cognitive effort and for stress effect, which could be used during cognitive assessment.
We assessed these markers during the use of the Montreal Cognitive Assessment (MoCA) before and after cardiac surgery, which is known to involve cognitive decline in up to 30%-50% of elderly patients.
The major findings of the study, for the largest group of patients, with preoperative MoCA in the intermediate range, were that the decline is significantly associated (1) with higher preoperative cognitive effort and (2) with higher postoperative stress effect during the test.
These findings, as well as preliminary additional ones, suggest a potential importance for monitoring cognitive effort and stress effect during assessment in general, and specifically during perioperative assessment.
Easy-to-use markers could improve the efficacy of cognitive assessment and direct treatment generally, and specifically for perioperative decline.
认知评估基于不同测试中的表现。然而，这种表现可能会受到一方面缺乏有效努力，另一方面受到过多压力的阻碍。尽管它们的影响已被认识到，但目前还没有有效的工具来测量认知努力或认知评估过程中的应激效应。我们开发了实时的认知努力和应激效应的电生理标志物，可以在认知评估过程中使用。
我们在心脏手术后使用蒙特利尔认知评估（MoCA）之前和之后评估了这些标志物，已知这种手术会导致多达 30%-50%的老年患者出现认知能力下降。
对于最大的一组术前 MoCA 处于中等范围的患者，该研究的主要发现是，下降与（1）更高的术前认知努力和（2）测试期间更高的术后应激效应显著相关。
这些发现，以及初步的其他发现，表明在评估过程中监测认知努力和应激效应具有潜在的重要性，特别是在围手术期评估中。
易于使用的标志物可以提高认知评估的效果，并普遍指导治疗，特别是针对围手术期的下降。
