Rapid in-person cognitive screening in the preoperative setting: Test considerations and recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI)

Arias, Franchesca; Wiggins, Margaret E.; Urman, Richard D.; Armstrong, Rebecca; Pfeifer, Kurt; Bader, Angela M.; Libon, David J.; Chopra, Anita; Price, Catherine C.

doi:10.1016/j.jclinane.2020.109724

Cited by 38 publications

(34 citation statements)

References 72 publications

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“…In addition, our geriatric experts recommend specific domains based on their clinical experience. These should include the components of formal frailty assessment, 5 cognitive assessment, 11 social history and vulnerabilities, physical examination, and discussion of advance directives (ADs) and advance care planning (ACP), as detailed below.…”

Section: Domains Of the Comprehensive Geriatric Assessmentmentioning

confidence: 99%

“…Preoperative cognitive screening is recommended by the ACS and SPAQI as part of the evaluation for patients older than 65 years 6,11 . The preoperative prevalence of impaired cognitive function, assessed by the MiniCog, a validated, easy‐to‐use, and reliable test, was shown to be as high as 33% in a population of patients 65 years or older undergoing elective procedures 14 .…”

Section: Cognitive Assessmentmentioning

confidence: 99%

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Launching a Geriatric Surgery Center: Recommendations from the Society for Perioperative Assessment and Quality Improvement

Cooper

Abbett

Feng

et al. 2020

J American Geriatrics Society

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To prepare for the increasing numbers of older adults undergoing surgery, the American College of Surgeons (ACS) has recently launched the Geriatric Surgery Verification Program with the goal of encouraging the creation of centers of geriatric surgery. Meanwhile, the Society for Perioperative Assessment and Quality Improvement (SPAQI) has published recommendations for the preoperative management of frailty, which state that teams should actively screen for frailty before surgery and that pathways, including geriatric comanagement, shared decision‐making, and multimodal prehabilitation, should be embedded in routine care to help improve patient outcomes. Both SPAQI and the ACS advocate for a multidisciplinary approach to improve the value of care for older adults undergoing surgery. However, the best way to implement geriatric services in the surgical setting is yet to be determined. In this statement, we will describe the SPAQI recommendations for launching a geriatric surgery center and the process by which its value should be assessed over time.

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Section: Domains Of the Comprehensive Geriatric Assessmentmentioning

confidence: 99%

Section: Cognitive Assessmentmentioning

confidence: 99%

Launching a Geriatric Surgery Center: Recommendations from the Society for Perioperative Assessment and Quality Improvement

Cooper

Abbett

Feng

et al. 2020

J American Geriatrics Society

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“…There are various screening tools that are used for pre-operative evaluation of cognitive impairment, such as the MMSE, the MoCA, the Mini-Cog, and the Clock Drawing Test (Arias et al, 2020;Hasan et al, 2020). The MMSE (Folstein et al, 1975) and the MoCA (Nasreddine et al, 2005) are two of the most widely used cognitive screening tools (Cheng et al, 2012;Evered et al, 2011;Lingehall et al, 2017;Partridge et al, 2014;Smith & Yeow, 2016), both in clinical settings and in research.…”

Section: Introductionmentioning

confidence: 99%

“…Pre‐operative assessment of cognitive impairment is vital for predicting, preventing, monitoring, and early recognition of the development of postoperative complications, so that targeted interventions can be introduced early to optimize the postoperative outcome of older surgical patients (Hasan et al., 2020; Oresanya et al., 2014). Given the number of older people undergoing surgery has increased even faster than the rate of population ageing over the past two decades (Jablonski & Urman, 2019), routinely screen cognitive function for older patients pre‐operatively has been urgently proposed (Arias et al., 2020; Hasan et al., 2020).…”

Section: Introductionmentioning

confidence: 99%

Conversion between Mini‐Mental State Examination and Montreal Cognitive Assessment scores in older adults undergoing selective surgery using Rasch analysis

Chen

Wen

Wang

et al. 2020

Journal of Advanced Nursing

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Aims: To develop and validate a conversion table between the MMSE and the MoCA using Rasch analysis in older adults undergoing selective surgery and examine its diagnostic accuracy in detecting cognitive impairment. Design: Cross-sectional study. Methods: Older patients [N = 129; age 66.0 (4.6) years, education 7.7 (3.5) years] undergoing elective surgery were recruited from December 2017 to June 2018. All participants completed the MMSE and MoCA and 113 of them completed a battery of neuropsychological tests. Common person linking based on Rasch analysis was performed to develop the conversion table. The conversions were validated by calculating the intraclass correlation coefficient (ICC), score differences between actual and converted scores, and root mean squared error of the difference (RMSE). The diagnostic accuracy of the conversions for detecting cognitive impairment was also tested. Results: The MoCA [person measure: 1.3 (1.1) logits] was better targeted to the patients than the MMSE [person measure: 3.2 (1.3) logits]. Conversion from MoCA to MMSE scores (ICC 0.84, 95% CI 0.77-0.88; RMSE 1.36) was more precise than conversion from MMSE to MoCA (ICC 0.82, 95% CI 0.75-0.87; RMSE 2.56). Conversion from MoCA to MMSE demonstrated better diagnostic accuracy in detecting cognitive impairment than the actual MMSE, whereas conversion from MMSE to MoCA exhibited the opposite pattern. Conclusion: Conversion from MoCA to MMSE was more precise and had better diagnostic accuracy in detecting pre-operative cognitive impairment in older patients undergoing selective surgery than conversion from MMSE into MoCA. Impact: The finding is useful for interpreting, comparing, and integrating cognitive measurements in surgical settings and clinical research. Statistically sound conversion between MoCA and MMSE based on Rasch analysis is now possible for surgical setting and clinical research.

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“…Studies report that 20%‐30% of patients aged 65 years or more presenting for surgery have some form of pre‐existing cognitive impairment 6,7 . Preoperative neurocognitive screening may mitigate the risk of post‐operative complications, such as POD by facilitating perioperative planning and informed decision making between patients, families and medical staff 4,8‐10 . With the prominence of “same‐day” surgical admissions, the immediate perioperative period may be the only opportune time to assess the cognitive function of these patients, highlighting the need for brief and effective screening tools.…”

Section: Introductionmentioning

confidence: 99%

A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: A feasibility study

Buckley

Atkins

Fortunato

et al. 2020

Acta Anaesthesiol Scand

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Background We developed a digital clock drawing test (dCDT), an adaptation of the original pen and paper clock test, that may be advantageous over previous dCDTs in the perioperative environment. We trialed our dCDT on a tablet device in the preoperative period to determine the feasibility of administration in this setting. To assess the clinical utility of this test, we examined the relationship between the performance on the test and compared derived digital clock measures with the 4 A's Test (4AT), a delirium and cognition screening tool. Methods We recruited a sample of 102 adults aged 65 years and over presenting for elective surgery in a single tertiary hospital. Participants completed the 4AT, followed by both command and copy clock conditions of the dCDT. We recorded time‐based clock‐drawing metrics, alongside clock replications scored using the Montreal Cognitive Assessment (MoCA) clock scoring criteria. Results The dCDT had an acceptance rate of 99%. After controlling for demographic variables and prior tablet use, regression analyses showed higher 4AT scores were associated with greater dCDT time (seconds) for both command (β = 8.2, P = .020) and copy clocks (β = 12, P = .005) and lower MoCA‐based clock scores in both command (OR = 0.19, P = .001) and copy conditions (OR = 0.14, P = .012). Conclusion The digital clock drawing test is feasible to administer and is highly acceptable to older adults in a preoperative setting. We demonstrated a significant association between both the dCDT time and clock score metrics, with the established 4AT. Our results provide convergent validity of the dCDT in the preoperative setting.

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Rapid in-person cognitive screening in the preoperative setting: Test considerations and recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI)

Cited by 38 publications

References 72 publications

Launching a Geriatric Surgery Center: Recommendations from the Society for Perioperative Assessment and Quality Improvement

Launching a Geriatric Surgery Center: Recommendations from the Society for Perioperative Assessment and Quality Improvement

Conversion between Mini‐Mental State Examination and Montreal Cognitive Assessment scores in older adults undergoing selective surgery using Rasch analysis

A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: A feasibility study

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