Top

BMC Anesthesiology

Published in:

Open Access 01-12-2020 | Arterial Occlusive Disease | Research article

Preoperative assessment of cognitive function and risk assessment of cognitive impairment in elderly patients with orthopedics: a cross-sectional study

Authors: Shuyuan Gan, Yang Yu, Jiateng Wu, Xiaodong Tang, Yueying Zheng, Mingcang Wang, Shengmei Zhu

Published in: BMC Anesthesiology | Issue 1/2020

Abstract

Background

Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. Nevertheless, cognitive impairment in a large proportion of geriatric patients has not been well identified and diagnosed.

Methods

This is a cross-sectional study. Mini-mental state examination scale was used to assess the cognitive function of elderly patients aged ≥65 years undergoing orthopedic surgery preoperatively. The baseline, living habits and laboratory examination results of two groups were compared, and a multivariable logistic regression model was used to identify independent predictors of preoperative cognitive impairment.

Results

A total of 374 elderly patients with orthopedic surgery indications met the inclusion criteria, and 28.61% of them had preoperative cognitive impairment. Multivariable logistic regression analysis showed that age (OR = 1.089, P < 0.001), subjective sleep disorders (OR = 1.996, P = 0.021), atherosclerosis (OR = 2.367, P = 0.017), and high cholesterol level (OR = 1.373, P = 0.028) were independent risk factors for preoperative cognitive impairment, while high education level performed as a protective factor (compared with the illiterate group, primary school group: OR = 0.413, P = 0.009; middle school or above group: OR = 0.120, P < 0.001).

Conclusions

The prevalence of preoperative cognitive dysfunction in geriatric elective orthopedic surgical patients was high. Our study identified venerable age, low level of education, subjective sleep disorders, atherosclerosis, and high cholesterol level as risk factors for preoperative cognitive impairment in these patients. Understanding these risk factors contributes to assisting in prevention and directed interventions for the high-risk population.

Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215(4):453–66. https://doi.org/10.1016/j.jamcollsurg.2012.06.017.CrossRefPubMed

Finlayson E, Zhao S, Boscardin WJ, Fries BE, Landefeld CS, Dudley RA. Functional status after colon cancer surgery in elderly nursing home residents. J Am Geriatr Soc. 2012;60(5):967–73. https://doi.org/10.1111/j.1532-5415.2012.03915.x.CrossRefPubMedPubMedCentral

Beffa LR, Petroski GF, Kruse RL, Vogel TR. Functional status of nursing home residents before and after abdominal aortic aneurysm repair. J Vasc Nurs. 2015;33(3):106–11. https://doi.org/10.1016/j.jvn.2015.02.003.CrossRefPubMedPubMedCentral

Blitz JD, Kendale SM, Jain SK, Cuff GE, Kim JT, Rosenberg AD. Preoperative evaluation clinic visit is associated with decreased risk of in-hospital postoperative mortality. Anesthesiology. 2016;125(2):280–94. https://doi.org/10.1097/ALN.0000000000001193.CrossRefPubMed

Amini S, Crowley S, Hizel L, Arias F, Libon DJ, Tighe P, et al. Feasibility and rationale for incorporating frailty and cognitive screening protocols in a preoperative anesthesia clinic. Anesth Analg. 2019;129(3):830–8. https://doi.org/10.1213/ANE.0000000000004190.CrossRefPubMedPubMedCentral

Plassman BL, Langa KM, Fisher GG, Heeringa SG, Weir DR, Mary Beth O, et al. Prevalence of cognitive impairment without dementia in the United States. Ann Intern Med. 2008;148(6):427–34. https://doi.org/10.7326/0003-4819-148-6-200803180-00005.CrossRefPubMedPubMedCentral

Hugo J, Ganguli M. Dementia and cognitive impairment: epidemiology, diagnosis, and treatment. Clin Geriatr Med. 2014;30(3):421–42. https://doi.org/10.1016/j.cger.2014.04.001.CrossRefPubMedPubMedCentral

Partridge JS, Dhesi JK, Cross JD, Lo JW, Taylor PR, Bell R, et al. The prevalence and impact of undiagnosed cognitive impairment in older vascular surgical patients. J Vasc Surg. 2014;60(4):1002–1011.e1003. https://doi.org/10.1016/j.jvs.2014.04.041.CrossRefPubMed

Tully PJ, Baune BT, Baker RA. Cognitive impairment before and six months after cardiac surgery increase mortality risk at median 11 year follow-up: a cohort study. Int J Cardiol. 2013;168(3):2796–802. https://doi.org/10.1016/j.ijcard.2013.03.123.CrossRefPubMed

10.

Kassie GM, Nguyen TA, Kalisch Ellett LM, Pratt NL, Roughead EE. Preoperative medication use and postoperative delirium: a systematic review. BMC Geriatr. 2017;17(1):298. https://doi.org/10.1186/s12877-017-0695-x.CrossRefPubMedPubMedCentral

11.

Ravi B, Pincus D, Choi S, Jenkinson R, Wasserstein DN, Redelmeier DA. Association of duration of surgery with postoperative delirium among patients receiving hip fracture repair. JAMA Netw Open. 2019;2(2):e190111. https://doi.org/10.1001/jamanetworkopen.2019.0111.CrossRefPubMedPubMedCentral

12.

Su X, Meng ZT, Wu XH, Cui F, Li HL, Wang DX, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial. Lancet. 2016;388(10054):1893–902. https://doi.org/10.1016/s0140-6736(16)30580-3.CrossRefPubMed

13.

Deiner S, Luo X, Lin HM, Sessler DI, Saager L, Sieber FE, et al. Intraoperative infusion of dexmedetomidine for prevention of postoperative delirium and cognitive dysfunction in elderly patients undergoing major elective noncardiac surgery: a randomized clinical trial. JAMA Surg. 2017;152(8):e171505. https://doi.org/10.1001/jamasurg.2017.1505.CrossRefPubMedPubMedCentral

14.

Li D, Liu H. Cognitive function assessment should be included in preoperative evaluation. J Biomed Res. 2017;32(3):161–3. https://doi.org/10.7555/jbr.32.20180008.CrossRef

15.

Culley DJ, Flaherty D, Reddy S, Fahey MC, Rudolph J, Huang CC, et al. Preoperative cognitive stratification of older elective surgical patients: a cross-sectional study. Anesth Analg. 2016;60(6):241–3. https://doi.org/10.1213/ANE.0000000000001277.CrossRef

16.

Mahanna-Gabrielli E, Schenning KJ, Eriksson LI, Browndyke JN, Wright CB, Evered L, et al. State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018. Br J Anaesth. 2019;123(4):464–78. https://doi.org/10.1016/j.bja.2019.07.004.CrossRefPubMed

17.

Association GBoCM. Suggestions from Chinese experts on preoperative evaluation of elderly patients (in Chinese). Chin J Geriatr. 2015;34(11):1273–80. https://doi.org/10.3760/cma.j.issn.0254-9026.2015.11.033.CrossRef

18.

Xue J, Li J, Liang J, Chen S. The prevalence of mild cognitive impairment in China: a systematic review. Aging Dis. 2018;9(4):706–15. https://doi.org/10.14336/AD.2017.0928.CrossRefPubMedPubMedCentral

19.

Luo G, Han J, Ju Q, Qiao J, Yang J, Wu C, et al. Applicability of MMSE in West China: who is more suitable (in Chinese). Chin Ment Health J. 2002;016(004):246–8, 233. https://doi.org/10.3321/j.issn:1000-6729.2002.04.008.CrossRef

20.

Creavin ST, Wisniewski S, Noel-Storr AH, Trevelyan CM, Hampton T, Rayment D, et al. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev. 2016;(1):Cd011145. https://doi.org/10.1002/14651858.CD011145.pub2.

21.

Evered LA, Silbert BS, Scott DA, Maruff P, Ames D, Choong PF. Preexisting cognitive impairment and mild cognitive impairment in subjects presenting for total hip joint replacement. Anesthesiology. 2011;114(6):1297–304. https://doi.org/10.1097/ALN.0b013e31821b1aab.CrossRefPubMed

22.

Lee YS, Kim YB, Lee SH, Park YS, Park SW. The prevalence of undiagnosed presurgical cognitive impairment and its postsurgical clinical impact in older patients undergoing lumbar spine surgery. J Korean Neurosurg Soc. 2016;59(3):287–91. https://doi.org/10.3340/jkns.2016.59.3.287.CrossRefPubMedPubMedCentral

23.

Adogwa O, Elsamadicy AA, Sergesketter A, Vuong VD, Moreno J, Cheng J, et al. Independent association between preoperative cognitive status and discharge location after surgery: a strategy to reduce resource use after surgery for deformity. World Neurosurg. 2018;110:e67–72. https://doi.org/10.1016/j.wneu.2017.10.081.CrossRefPubMed

24.

Francisco José TS, Ángel B-V, Eduardo RD, Enmanuel SM, David CP, Juan Ramón DP, et al. Severity of cognitive impairment as a prognostic factor for mortality and functional recovery of geriatric patients with hip fracture. Geriatr Gerontol Int. 2014;15(3):289–95. https://doi.org/10.1111/ggi.12271.CrossRef

25.

Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Br J Anaesth. 2018;121(5):1005–12. https://doi.org/10.1016/j.bja.2017.11.087.CrossRefPubMedPubMedCentral

26.

Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-20181. J Alzheimers Dis. 2018;66(1):1–10. https://doi.org/10.3233/jad-189004.CrossRefPubMed

27.

Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Anesthesiology. 2018;129(5):872–9. https://doi.org/10.1097/aln.0000000000002334.CrossRefPubMed

28.

Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Anesth Analg. 2018;127(5):1189–95. https://doi.org/10.1213/ane.0000000000003634.CrossRefPubMed

29.

Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Acta Anaesthesiol Scand. 2018;62(10):1473–80. https://doi.org/10.1111/aas.13250.CrossRefPubMed

30.

Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Can J Anaesth. 2018;65(11):1248–57. https://doi.org/10.1007/s12630-018-1216-x.CrossRefPubMed

31.

Murman DL. The impact of age on cognition. Semin Hear. 2015;36(3):111–21. https://doi.org/10.1055/s-0035-1555115.CrossRefPubMedPubMedCentral

32.

Smith NA, Yeow YY. Use of the Montreal Cognitive Assessment test to investigate the prevalence of mild cognitive impairment in the elderly elective surgical population. Anaesth Intensive Care. 2016;44(5):581–6. https://doi.org/10.1177/0310057X1604400507.CrossRefPubMed

33.

Subramaniyan S, Terrando N. Neuroinflammation and perioperative neurocognitive disorders. Anesth Analg. 2019;128(4):781–8. https://doi.org/10.1213/ane.0000000000004053.CrossRefPubMedPubMedCentral

34.

Izzo C, Carrizzo A, Alfano A, Virtuoso N, Capunzo M, Calabrese M, et al. The impact of aging on cardio and cerebrovascular diseases. Int J Mol Sci. 2018;19(2). https://doi.org/10.3390/ijms19020481.

35.

Badgwell B, Stanley J, Chang GJ, Katz MH, Lin HY, Ning J, et al. Comprehensive geriatric assessment of risk factors associated with adverse outcomes and resource utilization in cancer patients undergoing abdominal surgery. J Surg Oncol. 2013;108(3):182–6. https://doi.org/10.1002/jso.23369.CrossRefPubMed

36.

Armstrong RA. Risk factors for Alzheimer’s disease. Folia Neuropathol. 2019;57(2):87–105. https://doi.org/10.5114/fn.2019.85929.CrossRef

37.

Lee J, Shih R, Feeney K, Langa KM. Gender disparity in late-life cognitive functioning in India: findings from the longitudinal aging study in India. J Gerontol B Psychol Sci Soc Sci. 2014;69(4):603–11. https://doi.org/10.1093/geronb/gbu017.CrossRefPubMedPubMedCentral

38.

Langa KM, Larson EB, Karlawish JH, Cutler DM, Kabeto MU, Kim SY, et al. Trends in the prevalence and mortality of cognitive impairment in the United States: is there evidence of a compression of cognitive morbidity? Alzheimers Dement. 2008;4(2):134–44. https://doi.org/10.1016/j.jalz.2008.01.001.CrossRefPubMedPubMedCentral

39.

Carmel S. Health and well-being in late life: gender differences worldwide. Front Med (Lausanne). 2019;6:218. https://doi.org/10.3389/fmed.2019.00218.CrossRef

40.

Ardila A, Moreno S. Neuropsychological test performance in Aruaco Indians: an exploratory study. J Int Neuropsychol Soc. 2001;7(4):510–5. https://doi.org/10.1017/S1355617701004076.CrossRefPubMed

41.

Wada M, Noda Y, Shinagawa S, Chung JK, Sawada K, Ogyu K, et al. Effect of education on Alzheimer’s disease-related neuroimaging biomarkers in healthy controls, and participants with mild cognitive impairment and Alzheimer’s disease: a cross-sectional study. J Alzheimers Dis. 2018;63(2):861–9. https://doi.org/10.3233/jad-171168.CrossRefPubMed

42.

Stern Y. Cognitive reserve in ageing and Alzheimer’s disease. Lancet Neurol. 2012;11(11):1006–12. https://doi.org/10.1016/s1474-4422(12)70191-6.CrossRefPubMedPubMedCentral

43.

Saleh AJ, Tang GX, Hadi SM, Yan L, Chen MH, Duan KM, et al. Preoperative cognitive intervention reduces cognitive dysfunction in elderly patients after gastrointestinal surgery: a randomized controlled trial. Med Sci Monit. 2015;21:798–805. https://doi.org/10.12659/MSM.893359.CrossRefPubMedPubMedCentral

44.

Yaffe K, Blackwell T, Kanaya AM, Davidowitz N, Barrett-Connor E, Krueger K. Diabetes, impaired fasting glucose, and development of cognitive impairment in older women. Neurology. 2004;63(4):658–63. https://doi.org/10.1212/01.wnl.0000134666.64593.ba.CrossRefPubMed

45.

Stough C, Pipingas A, Camfield D, Nolidin K, Savage K, Deleuil S, et al. Increases in total cholesterol and low density lipoprotein associated with decreased cognitive performance in healthy elderly adults. Metab Brain Dis. 2019. https://doi.org/10.1007/s11011-018-0373-5.

46.

Okocha O, Gerlach RM, Sweitzer B. Preoperative evaluation for ambulatory anesthesia: what, when, and how? Anesthesiol Clin. 2019;37(2):195–213. https://doi.org/10.1016/j.anclin.2019.01.014.CrossRefPubMed

47.

Vázquez-Narváez KG, Ulibarri-Vidales M. The patient with hypertension and new guidelines for therapy. Curr Opin Anaesthesiol. 2019;32(3):421–6. https://doi.org/10.1097/aco.0000000000000736.CrossRefPubMed

48.

Price BR, Wilcock DM, Weekman EM. Hyperhomocysteinemia as a risk factor for vascular contributions to cognitive impairment and dementia. Front Aging Neurosci. 2018;10:350. https://doi.org/10.3389/fnagi.2018.00350.CrossRefPubMedPubMedCentral

49.

Setien-Suero E, Suarez-Pinilla M, Suarez-Pinilla P, Crespo-Facorro B, Ayesa-Arriola R. Homocysteine and cognition: a systematic review of 111 studies. Neurosci Biobehav Rev. 2016;69:280–98. https://doi.org/10.1016/j.neubiorev.2016.08.014.CrossRefPubMed

50.

Sudduth TL, Powell DK, Smith CD, Greenstein A, Wilcock DM. Induction of hyperhomocysteinemia models vascular dementia by induction of cerebral microhemorrhages and neuroinflammation. J Cereb Blood Flow Metab. 2013;33(5):708–15. https://doi.org/10.1038/jcbfm.2013.1.CrossRefPubMedPubMedCentral

51.

Shastry S, Tyagi SC. Homocysteine induces metalloproteinase and shedding of beta-1 integrin in microvessel endothelial cells. J Cell Biochem. 2004;93(1):207–13. https://doi.org/10.1002/jcb.20137.CrossRefPubMed

52.

Pace-Schott EF, Spencer RM. Age-related changes in the cognitive function of sleep. Prog Brain Res. 2011;191:75–89. https://doi.org/10.1016/b978-0-444-53752-2.00012-6.CrossRefPubMed

53.

Naismith SL, Rogers NL, Hickie IB, Mackenzie J, Norrie LM, Lewis SJ. Sleep well, think well: sleep-wake disturbance in mild cognitive impairment. J Geriatr Psychiatry Neurol. 2010;23(2):123–30. https://doi.org/10.1177/0891988710363710.CrossRefPubMed

54.

Zhao C, Noble JM, Marder K, Hartman JS, Gu Y, Scarmeas N. Dietary patterns, physical activity, sleep, and risk for dementia and cognitive decline. Curr Nutr Rep. 2018;7(4):335–45. https://doi.org/10.1007/s13668-018-0247-9.CrossRefPubMedPubMedCentral

55.

Putilov AA, Munch MY, Cajochen C. Principal component structuring of the non-REM sleep EEG spectrum in older adults yields age-related changes in the sleep and wake drives. Curr Aging Sci. 2013;6(3):280–93. https://doi.org/10.2174/187460980603140101203412.CrossRefPubMed

56.

Cagnin A, Fragiacomo F, Camporese G, Turco M, Busse C, Ermani M, et al. Sleep-wake profile in dementia with lewy bodies, Alzheimer’s disease, and normal aging. J Alzheimers Dis. 2017;55(4):1529–36. https://doi.org/10.3233/jad-160385.CrossRefPubMed

57.

O'Bryant SE, Humphreys JD, Smith GE, Ivnik RJ, Graff-Radford NR, Petersen RC, et al. Detecting dementia with the mini-mental state examination in highly educated individuals. Arch Neurol. 2008;65(7):963–7. https://doi.org/10.1001/archneur.65.7.963.CrossRefPubMedPubMedCentral

58.

Trzepacz PT, Hochstetler H, Wang S, Walker B, Saykin AJ, Alzheimer’s Disease Neuroimaging I. Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults. BMC Geriatr. 2015;15:107. https://doi.org/10.1186/s12877-015-0103-3.CrossRefPubMedPubMedCentral

59.

McCleane GJ, Cooper R. The nature of pre-operative anxiety. Anaesthesia. 1990;45(2):153–5. https://doi.org/10.1111/j.1365-2044.1990.tb14285.x.CrossRefPubMed

60.

Gajdos C, Kile D, Hawn MT, Finlayson E, Henderson WG, Robinson TN. The significance of preoperative impaired sensorium on surgical outcomes in nonemergent general surgical operations. JAMA Surg. 2015;150(1):30–6. https://doi.org/10.1001/jamasurg.2014.863.CrossRefPubMed

61.

Chen SP, Bhattacharya J, Pershing S. Association of vision loss with cognition in older adults. JAMA Ophthalmol. 2017;135(9):963–70. https://doi.org/10.1001/jamaophthalmol.2017.2838.CrossRefPubMedPubMedCentral

Title: Preoperative assessment of cognitive function and risk assessment of cognitive impairment in elderly patients with orthopedics: a cross-sectional study
Authors: Shuyuan Gan
Yang Yu
Jiateng Wu
Xiaodong Tang
Yueying Zheng
Mingcang Wang
Shengmei Zhu
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Arterial Occlusive Disease
Mild Neurocognitive Disorder
Published in: BMC Anesthesiology / Issue 1/2020
Electronic ISSN: 1471-2253
DOI: https://doi.org/10.1186/s12871-020-01096-6

At a glance: The STEP trials

Springer Medicine

Preoperative assessment of cognitive function and risk assessment of cognitive impairment in elderly patients with orthopedics: a cross-sectional study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Ossification of the cervical anterior longitudinal ligament is an underdiagnosed cause of difficult airway: a case report and review of the literature

Volume of tidal gas movement in the nonventilated lung during one-lung ventilation and its relevant factors

Preoperative intravenous rehydration for patients with pheochromocytomas and paragangliomas: is it necessary? A propensity score matching analysis

Influence of measurement principle on total hemoglobin value

Exogenous hydrogen sulfide alleviates surgery-induced neuroinflammatory cognitive impairment in adult mice by inhibiting NO signaling

Deep sedation using propofol target-controlled infusion for gastrointestinal endoscopic procedures: a retrospective cohort study