Reliability In Neurocognitive Telemedicine Screening (RING)

August 7, 2026 updated by: Donald J Young, MD, FRCPC, University of British Columbia

Perioperative neurocognitive disorders are common after surgery and pre-existing cognitive impairment is an important risk factor. Current guidelines recommend identifying cognitive impairment before surgery; however, screening remains inconsistent, particularly when preoperative assessments are performed remotely.

This prospective observational diagnostic validation study aims to determine whether a modified Mini-Cog cognitive screening tool administered by telephone can reliably identify cognitive impairment in patients aged 65 years and older undergoing preoperative assessment. Telephone-based modified Mini-Cog results will be compared with standard in-person Mini-Cog assessments to evaluate agreement and feasibility. This study may improve access to preoperative cognitive screening and support optimization of surgical care for older adults.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Perioperative neurocognitive disorders (PND) are common and associated with significant morbidity and economic costs. One of the dominant risk factors for PND is pre-existing cognitive impairment (CI). The importance of detecting CI pre-operatively to facilitate patient selection for optimisation pathways and informed risk assessments is stressed in recent joint guidelines by the American College of Surgeons and the American Geriatrics Society.

Despite these recommendations, screening for pre-operative CI is inconsistently performed. One systematic barrier to CI screening is telemedicine, the use of which has recently seen an inflection point partly precipitated by the Coronavirus pandemic. Telemedicine enables the delivery of tertiary level patient-centred care over expanding geographical catchments, and is likely here to stay.

To date, no brief CI screening tool has been validated for perioperative use via telemedicine.

The Mini-Cog is a brief CI screening tool that is uniquely familiar to perioperative healthcare providers. It is validated in preoperative patients and performs favourably compared to other screening tools in the detection of CI. A Mini-Cog result consistent with CI is strongly associated with postoperative delirium, and is widely used as a trigger for geriatric optimization referral.

Validation of the Mini-Cog delivered via telemedicine is an important step towards improving patient access to CI screening.

Although video pre-operative assessments have been shown to promote high levels of patient and anesthesiologist satisfaction6, it is our local experience that video call technology is less frequently available to older patients, can pose operational challenges for either participant, and reduces workflow flexibility.

Clock Drawing Test (CDT) is an integral part of the Mini-Cog, testing multiple domains of executive function and motor skills, and functioning as a 'distractor' between the registration and recall of three items.

A modified Mini-Cog has been used with illiterate patients unable to use an analogue clock. The CDT was replaced with a serial subtraction task (SST) as an alternate distractor. One study found the modified Mini-Cog correlates with a proxy-rated CI screening tool similarly to the standard Mini-Cog.

Whilst it not feasible to perform a Mini-Cog assessment during a telephone interview, the modified Mini-Cog is an attractive alternative. We therefore aim to validate the modified Mini-Cog assessment for use over the telephone.

Our study involves comparing the validated Mini-Cog with the modified Mini-Cog. Patients awaiting surgery performed the Modified-Mini-Cog with telemedicine and on a later date subsequently performed the validated standard Mini-Cog. We plan to analyse the concordance of the results.

Study Type

Observational

Enrollment (Estimated)

300

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

  • Name: Shirley Lim, BSN, BS-HRIM
  • Phone Number: 66378 604-875-4111
  • Email: shirley.lim@vch.ca

Study Locations

  • Canada
    • British Columbia
      • Vancouver, British Columbia, Canada, BC V5Z 1M9
        • Recruiting
        • Vancouver General Hospital
        • Contact:
        • Contact:
          • Shirley Lim, BSN, BS-HRIM
          • Phone Number: 66378 800-604-875-4111
        • Principal Investigator:
          • Donald Young, MD
        • Sub-Investigator:
          • Stewart Brown, MD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

This study will include adults aged 65 years and older who are scheduled for elective surgery and undergoing preoperative anesthetic assessment at Vancouver General Hospital or University of British Columbia Hospital. Participants will be recruited from the Pre-Admission Clinic referral list and will complete a modified Mini-Cog cognitive screening assessment by telephone followed by a standard in-person Mini-Cog assessment during their preoperative visit. The study population represents older adults undergoing surgical evaluation who do not have a known diagnosis of cognitive impairment.

Description

Inclusion Criteria:

  1. Patients with age >65 at time of listing for pre-operative assessment.
  2. Patients with a conversational understanding of English language.
  3. Patients scheduled for in-person consult with an anaesthesiologist.
  4. Patients awaiting surgery at Vancouver General Hospital or University of British Columbia Hospital.

Exclusion Criteria:

1. Patients with known cognitive impairment.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Concordance between telephone-administered modified Mini-Cog and standard in-person Mini-Cog assessment
Time Frame: Within 1-2 weeks of telephone assessment
Agreement between modified Mini-Cog scores obtained by telephone and standard in-person Mini-Cog scores in identifying cognitive impairment using the established Mini-Cog cutoff score.
Within 1-2 weeks of telephone assessment

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Sensitivity and specificity of telephone modified Mini-Cog
Time Frame: Within 1-2 weeks of telephone assessment
Sensitivity and specificity of the telephone-administered modified Mini-Cog for detection of cognitive impairment compared with the in-person Mini-Cog assessment.
Within 1-2 weeks of telephone assessment
Completion time of modified Mini-Cog assessment
Time Frame: During each assessment
Time required to complete the telephone and in-person Mini-Cog assessments.
During each assessment
Feasibility of telephone-based cognitive screening
Time Frame: During telephone assessment
Proportion of participants able to complete the telephone-administered modified Mini-Cog assessment.
During telephone assessment

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of British Columbia

Collaborators

Vancouver General Hospital

Investigators

  • Study Director: Stewart Brown, MD, University of British Columbia

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 2, 2023

Primary Completion (Estimated)

December 31, 2026

Study Completion (Estimated)

January 30, 2027

Study Registration Dates

First Submitted

August 7, 2026

First Submitted That Met QC Criteria

August 7, 2026

First Posted (Actual)

August 12, 2026

Study Record Updates

Last Update Posted (Actual)

August 12, 2026

Last Update Submitted That Met QC Criteria

August 7, 2026

Last Verified

August 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • H22-03455

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data will not be shared. Data will be stored securely and access will be limited to authorized study personnel in accordance with institutional policies and ethical requirements.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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