Preoperative Cognitive Screening with the Mini-Cog test: Evaluating Prevalence and Risk Factors
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Abstract
Background: Cognitive disorders are emerging as critical determinants of surgical outcomes, particularly among middle-aged and elderly patients. This study aimed to investigate the prevalence of cognitive impairment and its associated risk factors in patients aged 40 years and above attending a pre-anesthesia clinic.
Methods: In this cross-sectional study, 300 patients were assessed using the Mini-Cog test at Hospital's pre-anesthesia clinic between January 2023 and June 2024. Comprehensive demographic data, including educational levels and medical histories, were recorded. Statistical analyses were conducted to evaluate the association between cognitive impairment and clinical variables such as diabetes and hypertension.
Results: Cognitive impairment was prevalent in 71% of the participants, with lower educational attainment being a significant predictor (P value < 0.001). Diabetic patients exhibited a higher prevalence of cognitive impairment compared to non-diabetics (P value= 0.092). No statistically significant association was found between hypertension and cognitive impairment (P value= 0.4).
Conclusion: The study highlights a high prevalence of cognitive impairment in preoperative patients, particularly among those with limited educational backgrounds and diabetes. The findings emphasize the need for routine cognitive screening using tools like the Mini-Cog in preoperative assessments, allowing for early identification of at-risk patients and the implementation of tailored interventions to enhance surgical outcomes.
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[10] Kullmann S, Heni M, Hallschmid M, Fritsche A, Preissl H, Häring HU. Brain insulin resistance and its role in cognitive disorders. Physiol Rev. 2016; 96(4): 1169-209.
[11] Gao H, Ma HJ, Li YJ, Yin C, Li Z. Prevalence and risk factors of postoperative delirium after spinal surgery: A meta-analysis. J Orthop Surg Res. 2020; 15(1): 138.
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[14] Cheng ST. Cognitive reserve and the prevention of dementia: The role of physical and cognitive activities. Curr Psychiatry Rep. 2016; 18(9): 85.
[15] Biessels GJ, Strachan MW, Visseren FL, Kappelle LJ, Whitmer RA. Dementia and cognitive decline in type 2 diabetes and prediabetic stages: Towards targeted interventions. Lancet Neurol. 2008; 7(3): 182-90.
[16] Brands AM, Biessels GJ, De Haan EH, Kappelle LJ, Kessels RP. The effects of type 1 diabetes on cognitive performance: a meta-analysis. Diabetes Care. 2005; 28(3): 726-35.
[17] Yaffe K, Blackwell T, Kanaya AM, Davidowitz N, Barrett-Connor E, Krueger K. Diabetes, impaired fasting glucose, and development of cognitive impairment in older women. Neurology. 2004; 63(4): 658-63.
[18] Whitmer RA, Gustafson DR, Barrett-Connor E, Haan MN, Gunderson EP, Yaffe K. Central obesity and increased risk of dementia more than three decades later. Neurology. 2008; 71(14):1057-64.
[19] Mf, F. Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res. 1975; 12(3): 189-98.
[20] Tsoi KK, Chan JY, Hirai HW, Wong SY, Kwok TC. Cognitive tests to detect dementia: A systematic review and meta-analysis. JAMA Intern Med. 2015; 175(9): 1450-8.
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[22] Newman MF, Mathew JP, Grocott HP, Mackensen GB, Monk T, Welsh-Bohmer KA, et al. Central nervous system injury associated with cardiac surgery. Lancet. 2007; 368(9536): 694-703.
[23] Rudolph JL, Babikian VL, Treanor P, Pochay VE, Wigginton JB, Crittenden MD, et al. Microemboli are not associated with delirium after coronary artery bypass graft surgery. Perfusion. 2009; 24(6):409-15.
[24] Crosby G, Culley DJ. Anesthesia, the aging brain, and the surgical patient. Can J Anaesth. 2003; 50:R60-4.
[25] Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery. Br J Anaesth. 2017; 119(6): 1009-17.
[26] Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth. 2009; 103(Suppl_1): i41-6.
[27] Sweeney MD, Montagne A, Sagare AP, Nation DA, Schneider LS, Chui HC, et al. Vascular dysfunction—The disregarded partner of Alzheimer’s disease. Alzheimers Dement. 2018; 14(10): 1174-85.
[28] Jack CR Jr, Bennett DA, Blennow K, Carrillo MC, Dunn B, Haeberlein SB, et al. NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease. Alzheimers Dement. 2018; 14(4): 535-62.
[29] Zetterberg H, Blennow K. From cerebrospinal fluid to blood: The third wave of fluid biomarkers for Alzheimer’s disease. J Alzheimers Dis. 2018; 64(s1): S271-S9.
[30] Kamali A, Beigi S, Shokrpour M, Pazuki S. The efficacy of ginger and dexmedetomidine in reducing postoperative nausea and vomiting in patients undergoing abdominal hysterectomy. Altern Ther Health Med. 2020; 26(2): 28-33.
[31] Karvandian K, Vajargah KT, Beigi S, Mohammadzadeh N. The association of seasonal variations and COVID-19 clinical features: A comparative study on the fourth and fifth waves. Int J Clin Pract. 2022; 2022(1): 8347103.
[32] Nabavian O, Samadi S, Beigi S, Sahebi L, Eslami B, Montaseri A. Quality of life comparison between front-line residents and medical students during COVID-19 pandemic. Arch Anesthesiol Crit Care. 2024; 10(3): 252-9.
[33] Karvandian K, Beigi S, Ataie-Ashtiani Z, Ashouri M, Mohammadzadeh N. Non-invasive ventilation via tracheostomy in COVID-19 patients requiring respiratory support: Case report. Arch Anesthesiol Crit Care. 2023; 9(2): 178-80.
[34] Cuomo A, Bimonte S, Forte CA, Botti G, Cascella M. Multimodal approaches to cognitive disorders in ICU settings. Cureus. 2022; 14.
[35] Howes MJ, Perry NS, Houghton PJ. Traditional plants for managing cognitive disorders. Phytother Res. 2003; 17(1): 1-18.
[2] Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner LA, Moss M. Postoperative delirium in elderly patients: Risk factors and outcomes. Ann Surg. 2009; 249(1): 173-8.
[3] Sprung J, Roberts RO, Weingarten TN, Nunes Cavalcante A, Knopman DS, Petersen RC, et al. Postoperative delirium and cognitive outcomes in elderly surgical patients. Br J Anaesth. 2017; 119(2): 316-23.
[4] Oresanya LB, Lyons WL, Finlayson E. Preoperative cognitive assessment in older surgical patients: A narrative review. JAMA. 2014; 311(20): 2110-20.
[5] Chen D, Chen J, Yang H, Liang X, Xie Y, Li S, et al. The Mini-Cog test and its application in predicting postoperative outcomes. Minerva Anestesiol. 2019; 85(11): 1193-200.
[6] Lee HB, Mears SC, Rosenberg PB, Leoutsakos JM, Gottschalk A, Sieber FE. Risk factors for postoperative delirium after hip fracture repair. J Am Geriatr Soc. 2011; 59(12): 2306-13.
[7] Bell B, Lin JJ, Seidenberg M, Hermann B. Cognitive disorders in temporal lobe epilepsy: Neurobiology and management. Nat Rev Neurol. 2011; 7(3): 154-64.
[8] Winston A, Spudich S. Cognitive disorders in people living with HIV. Lancet HIV. 2020; 7(7): e504-e13.
[9] Apple DM, Fonseca RS, Kokovay E. Neurogenesis and its implications for cognitive disorders. Brain Res. 2017; 1655: 270-6.
[10] Kullmann S, Heni M, Hallschmid M, Fritsche A, Preissl H, Häring HU. Brain insulin resistance and its role in cognitive disorders. Physiol Rev. 2016; 96(4): 1169-209.
[11] Gao H, Ma HJ, Li YJ, Yin C, Li Z. Prevalence and risk factors of postoperative delirium after spinal surgery: A meta-analysis. J Orthop Surg Res. 2020; 15(1): 138.
[12] Stern Y. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc. 2002; 8(3): 448-60.
[13] Scarmeas N, Stern Y. Cognitive reserve and lifestyle. J Clin Exp Neuropsychol. 2003; 25(5): 625-33.
[14] Cheng ST. Cognitive reserve and the prevention of dementia: The role of physical and cognitive activities. Curr Psychiatry Rep. 2016; 18(9): 85.
[15] Biessels GJ, Strachan MW, Visseren FL, Kappelle LJ, Whitmer RA. Dementia and cognitive decline in type 2 diabetes and prediabetic stages: Towards targeted interventions. Lancet Neurol. 2008; 7(3): 182-90.
[16] Brands AM, Biessels GJ, De Haan EH, Kappelle LJ, Kessels RP. The effects of type 1 diabetes on cognitive performance: a meta-analysis. Diabetes Care. 2005; 28(3): 726-35.
[17] Yaffe K, Blackwell T, Kanaya AM, Davidowitz N, Barrett-Connor E, Krueger K. Diabetes, impaired fasting glucose, and development of cognitive impairment in older women. Neurology. 2004; 63(4): 658-63.
[18] Whitmer RA, Gustafson DR, Barrett-Connor E, Haan MN, Gunderson EP, Yaffe K. Central obesity and increased risk of dementia more than three decades later. Neurology. 2008; 71(14):1057-64.
[19] Mf, F. Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res. 1975; 12(3): 189-98.
[20] Tsoi KK, Chan JY, Hirai HW, Wong SY, Kwok TC. Cognitive tests to detect dementia: A systematic review and meta-analysis. JAMA Intern Med. 2015; 175(9): 1450-8.
[21] Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53(4): 695-9.
[22] Newman MF, Mathew JP, Grocott HP, Mackensen GB, Monk T, Welsh-Bohmer KA, et al. Central nervous system injury associated with cardiac surgery. Lancet. 2007; 368(9536): 694-703.
[23] Rudolph JL, Babikian VL, Treanor P, Pochay VE, Wigginton JB, Crittenden MD, et al. Microemboli are not associated with delirium after coronary artery bypass graft surgery. Perfusion. 2009; 24(6):409-15.
[24] Crosby G, Culley DJ. Anesthesia, the aging brain, and the surgical patient. Can J Anaesth. 2003; 50:R60-4.
[25] Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery. Br J Anaesth. 2017; 119(6): 1009-17.
[26] Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth. 2009; 103(Suppl_1): i41-6.
[27] Sweeney MD, Montagne A, Sagare AP, Nation DA, Schneider LS, Chui HC, et al. Vascular dysfunction—The disregarded partner of Alzheimer’s disease. Alzheimers Dement. 2018; 14(10): 1174-85.
[28] Jack CR Jr, Bennett DA, Blennow K, Carrillo MC, Dunn B, Haeberlein SB, et al. NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease. Alzheimers Dement. 2018; 14(4): 535-62.
[29] Zetterberg H, Blennow K. From cerebrospinal fluid to blood: The third wave of fluid biomarkers for Alzheimer’s disease. J Alzheimers Dis. 2018; 64(s1): S271-S9.
[30] Kamali A, Beigi S, Shokrpour M, Pazuki S. The efficacy of ginger and dexmedetomidine in reducing postoperative nausea and vomiting in patients undergoing abdominal hysterectomy. Altern Ther Health Med. 2020; 26(2): 28-33.
[31] Karvandian K, Vajargah KT, Beigi S, Mohammadzadeh N. The association of seasonal variations and COVID-19 clinical features: A comparative study on the fourth and fifth waves. Int J Clin Pract. 2022; 2022(1): 8347103.
[32] Nabavian O, Samadi S, Beigi S, Sahebi L, Eslami B, Montaseri A. Quality of life comparison between front-line residents and medical students during COVID-19 pandemic. Arch Anesthesiol Crit Care. 2024; 10(3): 252-9.
[33] Karvandian K, Beigi S, Ataie-Ashtiani Z, Ashouri M, Mohammadzadeh N. Non-invasive ventilation via tracheostomy in COVID-19 patients requiring respiratory support: Case report. Arch Anesthesiol Crit Care. 2023; 9(2): 178-80.
[34] Cuomo A, Bimonte S, Forte CA, Botti G, Cascella M. Multimodal approaches to cognitive disorders in ICU settings. Cureus. 2022; 14.
[35] Howes MJ, Perry NS, Houghton PJ. Traditional plants for managing cognitive disorders. Phytother Res. 2003; 17(1): 1-18.
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How to Cite
1.
Karvandian K, Beigi S, Karimi P, Eslami B. Preoperative Cognitive Screening with the Mini-Cog test: Evaluating Prevalence and Risk Factors. Arch Anesth & Crit Care. 2025;.
