title: Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study.
abstract: Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. We hypothesized that preoperative cognitive screening can be performed in a busy preadmission evaluation center and that cognitive impairment is prevalent in elective geriatric surgical patients.
  
  
  
  We approached 311 patients aged 65 years and older presenting for preoperative evaluation before elective surgery in a prospective, observational, single-center study. Forty-eight patients were ineligible, and 63 declined. The remaining 200 were randomly assigned to the Mini-Cog (N =100) or Clock-in-the-Box [CIB; N = 100)] test. Study staff administered the test in a quiet room, and 2 investigators scored the tests independently. Probable cognitive impairment was defined as a Mini-Cog ≤ 2 or a CIB ≤ 5.
  
  
  
  The age of consenting patients was 73.7 ± 6.4 (mean ± SD) years. There were no significant differences between patients randomly assigned to the Mini-Cog and CIB test in age, weight, gender, education, ASA physical status, or Charlston Index. Overall, 23% of patients met criteria for probable cognitive impairment, and prevalence was virtually identical regardless of the test used; 22% screened with the Mini-Cog and 23% screened with the CIB scored as having probable cognitive impairment (P = 1.0 by χ analysis). Both tests had good interrater reliability (Krippendroff α = 0.86 [0.72-0.93] for Mini-Cog and 1 for CIB).
  
  
  
  Preoperative cognitive screening is feasible in most geriatric elective surgical patients and reveals a substantial prevalence of probable cognitive impairment in this population.
authors.affiliation: From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; †University of Cincinnati College of Medicine, Cincinnati, Ohio; ‡ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; §Department of Anesthesiology, Perioperative and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; ∥Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; ¶ Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School and Harvard School of Public Health, Boston, Massachusetts; and #Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Culley
authors.forename: Devon
authors.initials: D
authors.lastname: Flaherty
authors.forename: Srini
authors.initials: S
authors.lastname: Reddy
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Fahey
authors.forename: James
authors.initials: J
authors.lastname: Rudolph
authors.forename: Chuan Chin
authors.initials: CC
authors.lastname: Huang
authors.forename: Xiaoxia
authors.initials: X
authors.lastname: Liu
authors.forename: Zhongcong
authors.initials: Z
authors.lastname: Xie
authors.forename: Angela M
authors.initials: AM
authors.lastname: Bader
authors.forename: Bradley T
authors.initials: BT
authors.lastname: Hyman
authors.forename: Deborah
authors.initials: D
authors.lastname: Blacker
authors.forename: Gregory
authors.initials: G
authors.lastname: Crosby
mesh_terms: D000367:Age Factors; D000368:Aged; D001900:Boston / Q000453:epidemiology; D016009:Chi-Square Distribution; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors