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| Can Domain-Specific Performance on the Montreal Cognitive Assessment Identify Older Surgical Patients at Risk of Adverse Outcomes? A Multicenter Longitudinal Study. Ellene Yan1, 2, 3, Yasmin Alhamdah1, 2, 3, Eric Cheuk1, Aparna Saripella2, Frances Chung1, 2, 3. 1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.2Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.3Krembil Brain Institute, University Health Network, Toronto, ON, Canada |
Abstract
BACKGROUND: Impairment in specific cognitive domains may differentially influence surgical recovery. The Montreal Cognitive Assessment (MoCA), a 10-minute cognitive screening tool validated in surgical populations, may inform the associations between domain-specific impairments and surgical outcomes [1]. This post-hoc analysis investigated (1) domain-specific performance on the MoCA in older surgical patients preoperatively and (2) preoperative characteristics and adverse postoperative outcomes associated with poor domain-specific performance.
METHODS: This is a post-hoc analysis of the Detection of Cognitive Impairment (Detect CI) study [2]. Following ethics approval, 382 eligible participants ≥65 years old, who underwent elective non-cardiac surgery and had ≥8 years of education, completed the MoCA preoperatively. The MoCA assesses seven cognitive domains: executive/visuospatial function, naming, attention, language, abstraction, delayed recall, and orientation to date, month, year, day, place, and city. It is scored out of 30, with higher education-adjusted MoCA scores indicating greater cognitive performance. Clinical outcomes were available for 382 participants at 30 days and 379 at 90 days.
RESULTS: An education level of ≤12 years was significantly associated with poorer performance on executive/visuospatial function, naming, language, abstraction, and delayed recall. Of all MoCA domains, only orientation was associated with 30-day adverse outcomes after adjusting for confounding variables of age, sex, education, and/or American Society of Anesthesiologist class and multiplicity. Specifically, each unit decrease in orientation scores was associated with longer length of stay (β: 0.5) and higher adjusted odds of postoperative delirium (11-fold), all-cause complications (3-fold), non-home discharge (4-fold), and composite adverse outcomes (6-fold) (Table 1).
CONCLUSIONS: Of all cognitive domains assessed on the MoCA, only orientation predicted adverse outcomes within 30 days postoperatively. Assessing orientation to date, month, year, day, place, and city is likely practical and clinically relevant for guiding preoperative risk stratification. Reference:[1] J Clin Anesth, 97, 111551, 2024. [2] J Clin Anesth, 106, 111940, 2025.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: This is a post-hoc analysis of the Detection of Cognitive Impairment (Detect CI) study [2]. Following ethics approval, 382 eligible participants ≥65 years old, who underwent elective non-cardiac surgery and had ≥8 years of education, completed the MoCA preoperatively. The MoCA assesses seven cognitive domains: executive/visuospatial function, naming, attention, language, abstraction, delayed recall, and orientation to date, month, year, day, place, and city. It is scored out of 30, with higher education-adjusted MoCA scores indicating greater cognitive performance. Clinical outcomes were available for 382 participants at 30 days and 379 at 90 days.
RESULTS: An education level of ≤12 years was significantly associated with poorer performance on executive/visuospatial function, naming, language, abstraction, and delayed recall. Of all MoCA domains, only orientation was associated with 30-day adverse outcomes after adjusting for confounding variables of age, sex, education, and/or American Society of Anesthesiologist class and multiplicity. Specifically, each unit decrease in orientation scores was associated with longer length of stay (β: 0.5) and higher adjusted odds of postoperative delirium (11-fold), all-cause complications (3-fold), non-home discharge (4-fold), and composite adverse outcomes (6-fold) (Table 1).
CONCLUSIONS: Of all cognitive domains assessed on the MoCA, only orientation predicted adverse outcomes within 30 days postoperatively. Assessing orientation to date, month, year, day, place, and city is likely practical and clinically relevant for guiding preoperative risk stratification. Reference:[1] J Clin Anesth, 97, 111551, 2024. [2] J Clin Anesth, 106, 111940, 2025.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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