A brief review of practical preoperative cognitive screening tools.
OBJECTIVE
Preoperative cognitive impairment is associated with the development of postoperative delirium, a common and consequential complication of major surgery in older patients. Screening for cognitive impairment should become a routine part of the preoperative evaluation of older patients; however, its implementation is hampered by limited clinical time and resources. The objective of this review was to identify cognitive screening tools that could be easily incorporated into the evaluation of older patients before major surgery.


METHODS
Using strict inclusion and exclusion criteria, we searched PubMed over a 15-year period for short and simple cognitive screening tools. In addition, we reviewed studies that examined these cognitive screening tools in a perioperative environment.                                               SEARCH RESULTS:                          We identified six cognitive screening tools that could each be administered in 2.5 min or less. Among the tools, sensitivity for cognitive impairment ranged from 79-99%, while specificity ranged from 70-98%. Only one (Mini-Cog) of the six tools we identified had been tested in a perioperative environment.


CONCLUSIONS
Incorporating a cognitive screening assessment into the preoperative evaluation of older patients is feasible. More research is needed to validate cognitive screening tools in the perioperative setting.
Department of Anesthesia & Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, Room C-450, San Francisco, CA 94143-0648, USA. longs1@anesthesia.ucsf.edu
L Stephen
LS
Long
William A
WA
Shapiro
Jacqueline M
JM
Leung
D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis*; D003693:Delirium / Q000209:etiology*; D005240:Feasibility Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity