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Development of a Novel Self-administered Cognitive Assessment Tool and Normative Data for Older Adults

Monsch, Raphael J., MMed*; Burckhardt, Amélie C., MD; Berres, Manfred, PhD; Thomann, Alessandra E., MSc*,§; Ehrensperger, Michael M., PhD§; Steiner, Luzius A., MD, PhD*,∥; Goettel, Nicolai, MD*,∥

Journal of Neurosurgical Anesthesiology: April 2019 - Volume 31 - Issue 2 - p 218–226
doi: 10.1097/ANA.0000000000000510
Clinical Investigations
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Background: Preexisting cognitive impairment in surgical patients is one of the leading risk factors for adverse cognitive outcomes such as postoperative delirium and postoperative cognitive dysfunction. We developed a self-administered tablet computer application intended to assess the individual risk for adverse postoperative cognitive outcomes. This cross-sectional study aimed to establish normative data for the tool.

Materials and Methods: Healthy volunteers aged 65 years and above were administered the Mini-Mental State Examination, Geriatric Depression Scale, and Consortium to Establish a Registry for Alzheimer’s Disease-Neuropsychological Assessment Battery to assess cognitive health. All subjects completed the tablet computer application without assistance. Primary outcome measure was the test performance. Regression models were built for each cognitive domain score with the covariates age, sex, and education in cognitively healthy subjects. Demographically adjusted standard scores (z-scores) were computed for each subtest.

Results: A total of 283 participants (155 women, 128 men) were included in the final analysis. Participants’ age was 73.8±5.2 years (mean±SD) and their level of education was 13.6±2.9 years. Mini-Mental State Examination score was 29.2±0.9 points, Geriatric Depression Scale score was 0.4±0.7 points, and Consortium to Establish a Registry for Alzheimer’s Disease-Neuropsychological Assessment Battery total score was 98.7±5.7 points. Older age was associated with poorer performance in the visual recognition task and in Trail Making Test B (P<0.05 after Bonferroni-Holm adjustments).

Conclusions: This study provides normative data for a novel self-administered tablet computer application that is ultimately designed to measure the individual risk for adverse postoperative cognitive outcomes in elderly patients.

*Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, University of Basel

§Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter Hospital

Department of Clinical Research, University of Basel, Basel

Department of Internal Medicine, Kantonsspital Baselland, Liestal, Switzerland

Department of Mathematics and Technology, University of Applied Sciences Koblenz, Remagen, Germany

R.J.M. and A.C.B. contributed equally.

This report describes a cross-sectional study. The authors state that the report includes the items in the STROBE checklist for cross-sectional studies.

L.A.S. has received speaker honoraria from Medtronic Schweiz (Münchenbuchsee, Switzerland), Covidien (Neuhausen am Rheinfall, Switzerland) MSD, (Luzern, Switzerland), Hamilton Medical (Bonaduz, Switzerland), Lilly (Vernier, Switzerland), and Orion Pharma (Zug, Switzerland). None of these fees were related to this study. N.G. is currently receiving a grant (pp-16-01) from the Propatient Research Foundation (Basel, Switzerland). The remaining authors have no conflicts of interest to disclose.

Address correspondence to: Nicolai Goettel, MD, Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, University of Basel, Spitalstrasse 21, Basel CH-4031, Switzerland (e-mail: nicolai.goettel@usb.ch).

Received December 20, 2017

Accepted April 17, 2018

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