Department of Anaesthesiology and Intensive Care, Tomas Bata Hospital, Zlin, Czech Republic.
Faculty of Medicine and Dentistry, Department of Public Health, Palacky University, Olomouc, Czech Republic.
BMC Geriatr. 2024 Aug 28;24(1):713. doi: 10.1186/s12877-024-05302-9.
Perioperative neurocognitive disorders are often neglected and undiagnosed. There are known risk factors for these disorders (e.g., higher levels of frailty, cognitive decline before surgery). However, these factors are usually not assessed in the daily clinical setting. One of the main reasons for this lack of examination is the absence of a suitable cognitive function test that can be used in acute clinical settings. The primary aim of this study was to determine correlations between preoperative and postoperative scores on three cognitive tests (the Mini Mental State Exam (MMSE), the Clock Drawing Test (CDT) and the Test of Gestures (TEGEST).
This was a prospective, monocentric, observational study that included one cohort of patients aged 65 years and older. Patients underwent acute or elective surgical operations. Preanaesthesia tests were administered. After the operation, the patients completed the same tests between the 2nd postoperative day and discharge. Preoperative and postoperative cognitive test scores were assessed.
This study included 164 patients. The arithmetic mean age was 74.5 years. The strongest correlations were observed between MMSE scores and TEGEST scores (r = 0.830 before and 0.786 after surgery, P < 0.001). To compare the MMSE and the TEGEST, the MMSE was divided into 2 categories-normal and impaired-and good agreement was found among 76.2% of the participants (ϰ = 0.515). If the TEGEST scoring system was changed so that scores of 4-6 indicated normal cognition and scores of 0-3 indicated cognitive impairment, the level of agreement would be 90.8%, ϰ = 0.817. Only 5.5% of the patients had impaired MMSE scores and normal TEGEST scores, whereas 3.7% of the respondents normal MMSE scores and impaired TEGEST scores.
According to our results, the TEGEST is a suitable option for assessing cognitive functioning before surgery among patients who are at risk of developing perioperative neurocognitive disorders. This study revealed that it is necessary to change the rating scale for the TEGEST so that scores of 4-6 indicate normal cognition and scores of 0-3 indicate cognitive impairment. In clinical practice, the use of the TEGEST may help to identify patients at risk of perioperative neurocognitive disorders.
围手术期神经认知障碍经常被忽视和漏诊。这些障碍存在已知的危险因素（例如，更高的脆弱程度、手术前的认知能力下降）。然而，这些因素在日常临床环境中通常未被评估。这种缺乏检查的一个主要原因是缺乏一种适合于急性临床环境的认知功能测试。本研究的主要目的是确定三个认知测试（简易精神状态检查（MMSE）、画钟测验（CDT）和手势测验（TEGEST）的术前和术后评分之间的相关性。
这是一项前瞻性、单中心、观察性研究，包括一个年龄在 65 岁及以上的患者队列。患者接受了急性或择期手术。进行术前测试。手术后，患者在术后第 2 天至出院期间完成相同的测试。评估了术前和术后的认知测试分数。
这项研究包括 164 名患者。算术平均年龄为 74.5 岁。MMSE 分数与 TEGEST 分数之间的相关性最强（术前 r=0.830，术后 r=0.786，P<0.001）。为了比较 MMSE 和 TEGEST，将 MMSE 分为正常和受损两类，发现 76.2%的参与者之间有良好的一致性（κ=0.515）。如果将 TEGEST 评分系统改为 4-6 分表示正常认知，0-3 分表示认知障碍，一致性水平将达到 90.8%，κ=0.817。只有 5.5%的患者 MMSE 评分受损而 TEGEST 评分正常，而 3.7%的患者 MMSE 评分正常而 TEGEST 评分受损。
根据我们的结果，TEGEST 是评估围手术期神经认知障碍风险患者手术前认知功能的合适选择。本研究表明，需要改变 TEGEST 的评分量表，使 4-6 分表示正常认知，0-3 分表示认知障碍。在临床实践中，使用 TEGEST 可能有助于识别围手术期神经认知障碍的风险患者。
