Cognitive Impairment (CI)
Conditions
Brief summary
This is a prospective multicenter cohort study, which will determine the prevalence of preoperative cognitive impairment (CI) using the Modified Telephone Interview for Cognitive Status (TICS-M), Eight-items interview to Differentiate Aging and Dementia (AD8), Telephone Montreal Cognitive Assessment (T-MoCA), and a single cognitive question from the Centers for Disease Control and Prevention (CDC). We would also determine the (1) the degree of agreement in screening results between each cognitive screening tool, (2) risk factors associated with screening positive for CI on each tool, and (3) the prevalence and/or trajectory of postoperative delirium, sleep disturbances, functional disability, instrumental activities of daily living (IADL), depression, quality of health, frailty, and pain in older surgical patients and its association with CI. This study will target older patients from the pre-operative clinics at Toronto Western Hospital and Mount Sinai Hospital (MSH), Toronto. Research staff will identify eligible patients who are scheduled for elective non-cardiac surgery. Written informed consent to participate in the study will be obtained from all patients.
Detailed description
The primary aim of this study is to (1) determine the prevalence of CI preoperatively in older surgical adults using virtual or telephone cognitive instruments, (2) determine the degree of agreement in screening results between each cognitive screening tool, and (3) explore the prevalence and trajectory of preoperative and postoperative outcomes and its association with CI. The outcomes include functional disability, IADL, sleep disturbances, quality of health, frailty, pain and depression. In a preoperative assessment 1-30 days prior to their scheduled surgery, patients will be asked via telephone to complete TICS-M and T-MoCA and an online questionnaire, including the AD8, CDC single cognitive question, World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), IADL, EuroQol 5 Dimension (EQ-5D-5L), Geriatric Depression Scale (GDS), 5-item FRAIL questionnaire, (FRAIL), visual analog pain scale (VAS pain), Single-item Sleep Quality Scale (SQS), Pittsburgh Sleep Quality Index (PSQI), and STOP questionnaire. These questionnaires will be repeated at follow-up visits at 30-, 90-, and 180-days post-surgery. At the hospital on post-operatively days 1-3, the Confusion Assessment Method (CAM), SQS, and VAS pain will be administered during the in-person visit. Chart review of delirium will also be conducted during patients' stay at the hospital.
Interventions
None listed
Sponsors
University Health Network, Toronto
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Inclusion criteria
Major Inclusion Criteria: * patients ≥ 65 years old; * patients scheduled for elective non-cardiac surgery * able to be contacted by telephone for follow up. Major
Exclusion criteria
* patients with previous dementia diagnosis, * patients scheduled for outpatient surgery,
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence of cognitive impairment via remote (virtual/telephone) assessment | Pre-surgery, 30-, 90- and 180-days post-surgery | Prevalence of cognitive impairment via remote (virtual/telephone) assessment as detected by the TICS-m (modified telephone interview for cognitive status). The TICS-m is scored from 0-50 with a score of 31 or below indicating cognitive impairment. |
| Degree of agreement in screening results (Cohen's Kappa (κ) coefficients) | Pre-surgery | The degree of agreement in screening results among the screening tools by calculating Cohen's Kappa (κ) coefficients. |
| The trajectories and prevalence or incidence of patient-reported outcomes | Pre-surgery, 30-, 90- and 180-days post-surgery | The trajectories and prevalence or incidence of functional disability as measured through the WHODAS 2.0 (World Health Organization Disability Assessment Schedule 2.0) in participants with vs without preoperative functional disability and in participants with vs without CI. A five-point rating scale is used for each question (none = 0, mild = 1, moderate = 2, severe = 3, extreme/cannot do = 4), and a higher WHODAS score indicates greater disability. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Days spent at home (DAH30) of participants post-surgery | 30-days post-surgery | DAH30 (days spent at home) at 30 days post-surgery |
| Mortality (number of participants who have died) post-surgery | 30-, 90- and 180-days post-surgery | Mortality |
| Number of participants who have been re-admitted to the hospital post-surgery | 30-, 90- and 180-days post-surgery | Hospital re-admission |
| The incidence of postoperative delirium post-surgery | Post-op day 1-3 | The incidence of postoperative delirium as measured by the Confusion Assessment Method (CAM) conducted by the research and nursing team and medical chart review. |
| Incidence of postoperative complications of participants post-surgery | 30-, 90- and 180-days post-surgery | All-cause postoperative complications |
| Incidence of re-operation or revision surgery post-surgery | 30-, 90- and 180-days post-surgery | Re-operation or revision surgery |
| Risk factors for screening positive on each cognitive screening tool | Pre-surgery | Preoperative risk factors associated with screening positive on each cognitive screening tool |
| Number of participants who have visited the emergency department post-surgery | 30-, 90- and 180-days post-surgery | Emergency department visit |
| Discharge destination of participants from chart review post-surgery | Post-op day 1-3 | Discharge destination (assess where the participant will be discharged to once out of hospital up to 30-days post-op) |
| Hospital length of stay (LOS) of participants post-surgery | Post-op day 1-3 | Hospital length of stay |
Countries
Canada
Outcome results
None listed