Preoperative Cognitive Screening of Elderly Surgical Patients
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 200
- 试验地点
- 1
- 主要终点
- Number of Patients With Probable Cognitive Impairment
研究概览
简要总结
The objectives of this pilot study are:
- to determine whether a short cognitive test battery administered in the preadmission test center can be used to cognitively stratify elderly patients presenting for elective surgical procedures.
- to evaluate the cost of cognitive screening in the preoperative testing center in terms of time and finances.
- to evaluate patient perceptions about the use of preoperative cognitive screening and their outcome expectations from their surgical procedure.
Subsequent investigations may evaluate whether preoperative cognitive screening is a predictor of postoperative morbidity and mortality in elderly surgical patients and whether a short cognitive screen administered in the preadmission testing center could be used to identify individuals with baseline cognitive impairments that should be refered for more formal cognitive evaluation.
详细描述
Detailed Description: Background and Significance: Approximately one-third of elective surgical patients seen in the BWH Preoperative Test Center are 65 years of age or older and national trends are similar. 15-30% of community dwelling elders have cognitive impairment. Such impairment cannot be identified based on chronologic age alone because there is considerable heterogeneity in cognitive abilities within and between age groups. In clinical practice, however, the brain is one major organ system that is not assessed formally preoperatively, so those with pre-existing cognitive deficits often go unrecognized. This is a potentially important deficiency given the advanced age of many surgical patients, the difficulty cognitive impairment may impose on ability to follow postoperative instructions, and the fact that research studies show an association between pre-existing cognitive impairment and risk for perioperative morbidity and mortality. Thus, preoperative cognitive performance may be a predictor and/or modifier of postoperative outcomes.1,2,3 Interestingly, no studies have documented patient perceptions regarding relationships between cognitive performance and patient outcomes among elders presenting for elective surgical procedures.
Objectives:
Objective 1: To determine whether each of two short cognitive tests administered in the preadmission test center are equally useful in cognitively stratify elderly patients presenting for elective surgical procedures.
Objective 2: To evaluate the cost of cognitive screening in the preoperative testing center in terms of time and finances.
Objective 3:To evaluate patient perceptions about the use of preoperative cognitive screening and their outcome expectations from their surgical procedure.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Patients 65 years and over were enrolled either to be screened with the Clock in the Box or MiniCog cognitive screening tools
排除标准
- •Patients under age 65 Patients with visual or hearing impairments that are not corrected Patients who do not speak and read English Patients having a formal diagnosis of dementia Patients with scheduled surgical procedures affecting the brain or cerebrovasculature (i.e. intracranial neurosurgery, carotid endarterectomy).
结局指标
主要结局
Number of Patients With Probable Cognitive Impairment
时间窗: Cognitive stratification occurred on the date the patient consented to the study at baseline. This data was presented in a publication in 2017 (Anesthesiology. 2017 Nov;127(5):765-774.)
Potential baseline predictors of the MiniCog and CIB scores on a risk ratio scale, Clock in box 0-8, Mini-Cog 0-5, higher values represent better scores. For the Mini-cog a score of less than or equal to 2 suggests probable cognitive impairment. For the Clock in the box, a score of less than or equal to 5 suggests probable cognitive impairment. The number of participants that scored less than or equal to 2 on the Mini-cog or less than or equal to 5 on the clock in the box are presented in the data table
次要结局
- Patient Perceptions of Preoperative Cognitive Screening(The data was obtained at the time of initial enrollment)
- Cost of Cognitive Screening in Terms of Time and Finances(duration of time undergoing preoperative evaluation in minutes.)
研究者
Gregory J. Crosby, M.D.
Physician
Brigham and Women's Hospital