Neuropsychological Tests in Post-operative Cognitive Dysfunction: Methods and Applications

Jun Liu, Kequn Huang, Binbin Zhu, Bin Zhou, Ahmad Khaled Ahmad Harb, Lin Liu, Xiang Wu, Jun Liu, Kequn Huang, Binbin Zhu, Bin Zhou, Ahmad Khaled Ahmad Harb, Lin Liu, Xiang Wu

Abstract

Post-operative cognitive dysfunction (POCD) is a neurological complication that relatively frequently occurs in older people after anesthesia/surgery, with varying durations and significant differences in the severity of cognitive impairment. POCD is mainly characterized by memory loss mostly without consciousness disorders, accompanied by abnormal emotions, behaviors, and language, mostly without consciousness disorder. The clinical performance of POCD lacks specificity but can reflect the severity of cognitive impairment in patients. The diagnosis of POCD cannot be separated from the evaluation of perioperative cognitive function of patients, and the more popular and accepted method is neuropsychological tests (NPTs).

Keywords: anesthesia; cognitive dysfunction; neuropsychological assessment; perioperative; surgery.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Liu, Huang, Zhu, Zhou, Ahmad Harb, Liu and Wu.

References

    1. Abildstrom H., Rasmussen L. S., Rentowl P., Hanning C. D., Rasmussen H., Kristensen P. A., et al. . (2000). Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly. Acta Anaesthesiol. Scand. 44, 1246–1251. 10.1034/j.1399-6576.2000.441010.x
    1. Amato I., Nanev A., Piantella S., Wilson K. E., Bicknell R., Heckenberg R., et al. . (2020). Assessing the utility of a virtual-reality neuropsychological test battery, 'CONVIRT', in detecting alcohol-induced cognitive impairment. Behav. Res. Methods. 132(Pt 10), 2850–2870. 10.3758/s13428-020-01485-2
    1. Attridge J., Zimmerman D., Rolin S., Davis J. J. (2020). Comparing Boston naming test short forms in a rehabilitation sample. Appl. Neuropsychol. Adult 1–6. 10.1080/23279095.2020.1811984. [Epub ahead of print].
    1. Backx R., Skirrow C., Dente P., Barnett J. H., Cormack F. K. (2020). Comparing web-based and lab-based cognitive assessment using the cambridge neuropsychological test automated battery: a within-subjects counterbalanced study. J. Med. Intern. Res. 22:e16792. 10.2196/16792
    1. Baker M. T., Moring J. C., Hale W. J., Mintz J., Young-McCaughan S., Bryant R. A., et al. . (2018). Acute assessment of traumatic brain injury and post-traumatic stress after exposure to a deployment-related explosive blast. Mil. Med. 183, e555–e563. 10.1093/milmed/usy100
    1. Battista P., Salvatore C., Berlingeri M., Cerasa A., Castiglioni I. (2020). Artificial intelligence and neuropsychological measures: the case of Alzheimer's disease. Neurosci. Biobehav. Rev. 114, 211–228. 10.1016/j.neubiorev.2020.04.026
    1. Bedford P. D. (1995). Adverse cerebral effects of anaesthesia on old people. Lancet 269, 259–263.
    1. Berger M., Murdoch D. M., Staats J. S., Chan C., Thomas J. P., Garrigues G. E., et al. . (2019). Flow cytometry characterization of cerebrospinal fluid monocytes in patients with postoperative cognitive dysfunction: a pilot study. Anesth. Analg. 129, e150–e154. 10.1213/ANE.0000000000004179
    1. Brand N., Jolles J. (1985). Learning and retrieval rate of words presented auditorily and visually. J. Gen. Psychol. 112, 201–210. 10.1080/00221309.1985.9711004
    1. Brearly T. W., Shura R. D., Martindale S. L., Lazowski R. A., Luxton D. D., Shenal B. V., et al. . (2017). Neuropsychological test administration by videoconference: a systematic review and meta-analysis. Neuropsychol. Rev. 27, 174–186. 10.1007/s11065-017-9349-1
    1. Bryden P. J., Roy E. A. (2005). A new method of administering the grooved pegboard test: performance as a function of handedness and sex. Brain Cogn. 58, 258–268. 10.1016/j.bandc.2004.12.004
    1. Bush S. S., Ruff R. M., Tröster A. I., Barth J. T., Koffler S. P., Pliskin N. H., et al. . (2005). Symptom validity assessment: practice issues and medical necessity NAN policy & planning committee. Arch. Clin. Neuropsychol. 20, 419–426. 10.1016/j.acn.2005.02.002
    1. Cahn-Hidalgo D., Estes P. W., Benabou R. (2020). Validity, reliability, and psychometric properties of a computerized, cognitive assessment test (Cognivue(®)). World J. Psychiatry 10, 1–11. 10.5498/wjp.v10.i1.1
    1. Cavaco S., Gonçalves A., Pinto C., Almeida E., Gomes F., Moreira I., et al. . (2013). Trail Making Test: regression-based norms for the Portuguese population. Arch. Clin. Neuropsychol. 28, 189–198. 10.1093/arclin/acs115
    1. Chung F., Lavelle P. A., McDonald S., Chung A., McDonald N. J. (1989). Cognitive impairment after neuroleptanalgesia in cataract surgery. Anesth. Analg. 68, 614–618. 10.1213/00000539-198905000-00013
    1. Ciesielska N., Sokołowski R., Mazur E., Podhorecka M., Polak-Szabela A., Kedziora-Kornatowska K. (2016). Is the montreal cognitive assessment (MoCA) test better suited than the mini-mental state examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatr. Polska 50, 1039–1052. 10.12740/PP/45368
    1. Daiello L. A., Racine A. M., Yun Gou R., Marcantonio E. R., Xie Z., Kunze L. J., et al. . (2019). Postoperative delirium and postoperative cognitive dysfunction: overlap and divergence. Anesthesiology 131, 477–491. 10.1097/ALN.0000000000002729
    1. Deiner S., Liu X., Lin H. M., Sieber F., Boockvar K., Sano M., et al. . (2019). Subjective cognitive complaints in patients undergoing major non-cardiac surgery: a prospective single centre cohort trial. Br. J. Anaesth. 122, 742–750. 10.1016/j.bja.2019.02.027
    1. Deng Y., Wang R., Li S., Zhu X., Wang T., Wu J., et al. . (2021). Methylene blue reduces incidence of early postoperative cognitive disorders in elderly patients undergoing major non-cardiac surgery: an open-label randomized controlled clinical trial. J. Clin. Anesth. 68:110108. 10.1016/j.jclinane.2020.110108
    1. Espenes J., Hessen E., Eliassen I. V., Waterloo K., Eckerström M., Sando S. B., et al. . (2020). Demographically adjusted trail making test norms in a Scandinavian sample from 41 to 84 years. Clin. Neuropsychol. 34, 110–126. 10.1080/13854046.2020.1829068
    1. Evered L., Silbert B., Knopman D. S., Scott D. A., DeKosky S. T., Rasmussen L. S., et al. . (2018). Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-20181. J. Alzheimer's Dis. 66, 1–10. 10.3233/JAD-189004
    1. Fodale V., Santamaria L. B., Schifilliti D., Mandal P. K. (2010). Anaesthetics and postoperative cognitive dysfunction: a pathological mechanism mimicking Alzheimer's disease. Anaesthesia 65, 388–395. 10.1111/j.1365-2044.2010.06244.x
    1. Folstein M. F., Folstein S. E., McHugh P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12, 189–198. 10.1016/0022-3956(75)90026-6
    1. Fong T. G., Davis D., Growdon M. E., Albuquerque A., Inouye S. K. (2015). The interface between delirium and dementia in elderly adults. Lancet Neurol. 14, 823–832. 10.1016/S1474-4422(15)00101-5
    1. Geng Y. J., Wu Q. H., Zhang R. Q. (2017). Effect of propofol, sevoflurane, and isoflurane on postoperative cognitive dysfunction following laparoscopic cholecystectomy in elderly patients: A randomized controlled trial. J. Clin. Anesth. 38, 165–171. 10.1016/j.jclinane.2017.02.007
    1. Goh S. C., Saw A. E., Kountouris A., Orchard J. W., Saw R. (2021). Neurocognitive changes associated with concussion in elite cricket players are distinct from changes due to post-match with no head impact. J. Sci. Med. Sport 24, 420–424. 10.1016/j.jsams.2020.10.005
    1. Heilbronner R. L., Sweet J. J., Morgan J. E., Larrabee G. J., Millis S. R. (2009). American academy of clinical neuropsychology consensus conference statement on the neuropsychological assessment of effort, response bias, and malingering. Clin. Neuropsychol. 23, 1093–1129. 10.1080/13854040903155063
    1. Hoffmann M. (ed.). (2020). Clinical Mentation Evaluation: A Connectomal Approach to Rapid and Comprehensive Assessment. Florida, 10.1007/978-3-030-46324-3
    1. Hoffmann M., Schmitt F., Bromley E. (2009). Comprehensive cognitive neurological assessment in stroke. Acta Neurol. Scand. 119, 162–171. 10.1111/j.1600-0404.2008.01101.x
    1. Houx P. J., Jolles J., Vreeling F. W. (1993). Stroop interference: aging effects assessed with the stroop color-word test. Exp. Aging Res. 19, 209–224. 10.1080/03610739308253934
    1. Jagtap S., Dawson D. R., Vandermorris S., Anderson N. D., Davids-Brumer N., Dar M., et al. . (2020). Known-groups and convergent validity of the telephone rey auditory verbal learning test total learning scores for distinguishing between older adults with amnestic cognitive impairment and subjective cognitive decline. Arch. Clin. Neuropsychol. 36:acaa085. 10.1093/arclin/acaa085
    1. Kang M. J., Kim S. Y., Na D. L., Kim B. C., Yang D. W., Kim E. J., et al. . (2019). Prediction of cognitive impairment via deep learning trained with multi-center neuropsychological test data. BMC Med. Inform. Decis. Making 19:231. 10.1186/s12911-019-0974-x
    1. Karr J. E., Iverson G. L. (2020). Interpreting high scores on the nih toolbox cognition battery: potential utility for detecting cognitive decline in high-functioning individuals. Neuropsychology. 34, 764–773. 10.1037/neu0000691
    1. Katsumata Y., Mathews M., Abner E. L., Jicha G. A., Caban-Holt A., Smith C. D., et al. . (2015). Assessing the discriminant ability, reliability, and comparability of multiple short forms of the boston naming test in an Alzheimer's disease center cohort. Dement. Geriatr. Cogn. Disorders 39, 215–227. 10.1159/000370108
    1. Kline R. P., Pirraglia E., Cheng H., De Santi S., Li Y., Haile M., et al. . (2012). Surgery and brain atrophy in cognitively normal elderly subjects and subjects diagnosed with mild cognitive impairment. Anesthesiology 116, 603–612. 10.1097/ALN.0b013e318246ec0b
    1. Klinger R. Y., Cooter M., Bisanar T., Terrando N., Berger M., Podgoreanu M. V., et al. . (2019). Intravenous lidocaine does not improve neurologic outcomes after cardiac surgery: a randomized controlled trial. Anesthesiology 130, 958–970. 10.1097/ALN.0000000000002668
    1. Kramer J. H., Mungas D., Possin K. L., Rankin K. P., Boxer A. L., Rosen H. J., et al. . (2014). NIH EXAMINER: conceptualization and development of an executive function battery. J. Int. Neuropsychol. Soc. 20, 11–19. 10.1017/S1355617713001094
    1. Kulaif T., Valle L. E. (2008). Alternative to the stroop color-word test for illiterate individuals. Clin. Neuropsychol. 22, 73–83. 10.1080/13854040601186964
    1. Langer T., Santini A., Zadek F., Chiodi M., Pugni P., Cordolcini V., et al. . (2019). Intraoperative hypotension is not associated with postoperative cognitive dysfunction in elderly patients undergoing general anesthesia for surgery: results of a randomized controlled pilot trial. J. Clin. Anesth. 52, 111–118. 10.1016/j.jclinane.2018.09.021
    1. Li W. X., Luo R. Y., Chen C., Li X., Ao J. S., Liu Y., et al. . (2019). Effects of propofol, dexmedetomidine, and midazolam on postoperative cognitive dysfunction in elderly patients: a randomized controlled preliminary trial. Chin. Med. J. 132, 437–445. 10.1097/CM9.0000000000000098
    1. Lu L., Bigler E. D. (2000). Performance on original and a Chinese version of trail making test part B: a normative bilingual sample. Appl. Neuropsychol. 7, 243–246. 10.1207/S15324826AN0704_6
    1. Lunardini F., Luperto M., Romeo M., Basilico N., Daniele K., Azzolino D., et al. . (2020). Supervised digital neuropsychological tests for cognitive decline in older adults: usability and clinical validity study. JMIR mHealth uHealth 8:e17963. 10.2196/17963
    1. Ma Y., Carlsson C. M., Wahoske M. L., Blazel H. M., Chappell R. J., Johnson S. C., et al. . (2020). Latent factor structure and measurement invariance of the NIH toolbox cognition battery in an Alzheimer's disease research sample. J. Int. Neuropsychol. Soc. 27, 412–425. 10.1017/S1355617720000922
    1. Marcopulos B., Łojek E. (2019). Introduction to the special issue: are modern neuropsychological assessment methods really “modern”? Reflections on the current neuropsychological test armamentarium. Clin. Neuropsychol. 33, 187–199. 10.1080/13854046.2018.1560502
    1. Mattlar C. E., Engblom E., Vesala P., Vänttinen E., Knuts L. R. (1991). The proportion of patients with cognitive impairment after coronary artery bypass surgery: an 8-month follow-up study. Psychother. Psychosom. 55, 145–150. 10.1159/000288422
    1. Memória C. M., Yassuda M. S., Nakano E. Y., Forlenza O. V. (2014). Contributions of the computer-administered neuropsychological screen for mild cognitive impairment (CANS-MCI) for the diagnosis of MCI in Brazil. Int. Psychogeriatr. 26, 1–9. 10.1017/S1041610214000726
    1. Miller J. B. (2019). Big data and biomedical informatics: Preparing for the modernization of clinical neuropsychology. Clin. Neuropsychol. 33, 287–304. 10.1080/13854046.2018.1523466
    1. Moller J. T., Cluitmans P., Rasmussen L. S., Houx P., Rasmussen H., Canet J., et al. . (1998). Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet 351, 857–861. 10.1016/S0140-6736(97)07382-0
    1. Moller J. T., Svennild I., Johannessen N. W., Jensen P. F., Espersen K., Gravenstein J. S., et al. . (1993). Perioperative monitoring with pulse oximetry and late postoperative cognitive dysfunction. Br. J. Anaesth. 71, 340–347. 10.1093/bja/71.3.340
    1. Monk T. G., Weldon B. C., Garvan C. W., Dede D. E., van der Aa M. T., Heilman K. M., et al. . (2008). Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology 108, 18–30. 10.1097/01.anes.0000296071.19434.1e
    1. Morrow S. A. (2013). Normative data for the Stroop color word test for a North American population. The Canadian journal of neurological sciences. Le J. Can. Sci. Neurol. 40, 842–847. 10.1017/S0317167100015997
    1. Murkin J. M., Martzke J. S., Buchan A. M., Bentley C., Wong C. J. (1995). A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery. II. Neurologic and cognitive outcomes. J. Thorac. Cardiovasc. Surg. 110, 349–362. 10.1016/S0022-5223(95)70230-X
    1. Nadelson M. R., Sanders R. D., Avidan M. S. (2014). Perioperative cognitive trajectory in adults. Br. J. Anaesth. 112, 440–451. 10.1093/bja/aet420
    1. Nasreddine Z. S., Phillips N. A., Bedirian V., Charbonneau S., Whitehead V., Collin I., et al. . (2005). The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc. 53, 695–699. 10.1111/j.1532-5415.2005.53221.x
    1. Newman M. F., Kirchner J. L., Phillips-Bute B., Gaver V., Grocott H., Jones R. H., et al. . (2001). Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N. Engl. Med. J. 344, 395–402. 10.1056/NEJM200102083440601
    1. Pérez-Belmonte L. M., Florido-Santiago M., Osuna-Sánchez J., Barbancho M. A., Millán-Gómez M., Jímenez-Navarro M. F., et al. . (2019). Screening versus brief domain-specific tests to assess long-term postoperative cognitive dysfunction after concomitant aortic valve replacement and coronary artery bypass grafting. J. Cardiovasc. Nurs. 34, 511–516. 10.1097/JCN.0000000000000596
    1. Periáñez J. A., Lubrini G., García-Gutiérrez A., Ríos-Lago M. (2021). Construct validity of the stroop color-word test: influence of speed of visual search, verbal fluency, working memory, cognitive flexibility, and conflict monitoring. Arch. Clin. Neuropsychol. 36, 99–111. 10.1093/arclin/acaa034
    1. Press Y. Punchik B. Kagan E. Berzak A. Freud T. Dwolatzky T. (2021). Methylphenidate for mild cognitive impairment: an exploratory 3-day, randomized, double-blind, placebo-controlled trial. Front. Med. 8:594228. 10.3389/fmed.2021.594228
    1. Quan C., Chen J., Luo Y., Zhou L., He X., Liao Y., et al. . (2019). BIS-guided deep anesthesia decreases short-term postoperative cognitive dysfunction and peripheral inflammation in elderly patients undergoing abdominal surgery. Brain Behav. 9:e01238. 10.1002/brb3.1238
    1. Rasmussen L. S., Johnson T., Kuipers H. M., Kristensen D., Siersma V. D., Vila P., et al. . (2003). Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol. Scand. 47, 260–266. 10.1034/j.1399-6576.2003.00057.x
    1. Rasmussen L. S., Larsen K., Houx P., Skovgaard L. T., Hanning C. D., Moller J. T., et al. . (2001). The assessment of postoperative cognitive function. Acta Anaesthesiol. Scand. 45, 275–289. 10.1034/j.1399-6576.2001.045003275.x
    1. Rasmussen L. S., Siersma V. D. (2004). Postoperative cognitive dysfunction: true deterioration versus random variation. Acta Anaesthesiol. Scand. 48, 1137–1143. 10.1111/j.1399-6576.2004.00502.x
    1. Rizzo J. R., Hudson T. E., Dai W., Birkemeier J., Pasculli R. M., Selesnick I., et al. . (2016). Rapid number naming in chronic concussion: eye movements in the King-Devick test. Ann. Clin. Transl. Neurol. 3, 801–811. 10.1002/acn3.345
    1. Rodriguez R. A., Rubens F. D., Wozny D., Nathan H. J. (2010). Cerebral emboli detected by transcranial Doppler during cardiopulmonary bypass are not correlated with postoperative cognitive deficits. Stroke 41, 2229–2235. 10.1161/STROKEAHA.110.590513
    1. Royse C. F., Andrews D. T., Newman S. N., Stygall J., Williams Z., Pang J., et al. . (2011). The influence of propofol or desflurane on postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery. Anaesthesia 66, 455–464. 10.1111/j.1365-2044.2011.06704.x
    1. Rudolph J. L., Marcantonio E. R., Culley D. J., Silverstein J. H., Rasmussen L. S., Crosby G. J., et al. . (2008). Delirium is associated with early postoperative cognitive dysfunction. Anaesthesia 63, 941–947. 10.1111/j.1365-2044.2008.05523.x
    1. Sage M. D., Bryden P. J., Roy E. A., Almeida Q. J. (2012). The relationship between the grooved pegboard test and clinical motor symptom evaluation across the spectrum of Parkinson's disease severity. J. Parkinson's Dis. 2, 207–213. 10.3233/JPD-2012-012093
    1. Sauër A. C., Veldhuijzen D. S., Ottens T. H., Slooter A. J. C., Kalkman C. J., van Dijk D. (2017). Association between delirium and cognitive change after cardiac surgery. Br. J. Anaesth. 119, 308–315. 10.1093/bja/aex053
    1. Scott E. P., Sorrell A., Benitez A. (2019). Psychometric properties of the NIH toolbox cognition battery in healthy older adults: reliability, validity, and agreement with standard neuropsychological tests. J. Int. Neuropsychol. Soc. 25, 857–867. 10.1017/S1355617719000614
    1. Silbert B., Evered L., Scott D. A., McMahon S., Choong P., Ames D., et al. . (2015). Preexisting cognitive impairment is associated with postoperative cognitive dysfunction after hip joint replacement surgery. Anesthesiology 122, 1224–1234. 10.1097/ALN.0000000000000671
    1. Steinmetz J., Christensen K. B., Lund T., Lohse N., Rasmussen L. S. (2009). Long-term consequences of postoperative cognitive dysfunction. Anesthesiology 110, 548–555. 10.1097/ALN.0b013e318195b569
    1. Steinmetz J., Siersma V., Kessing L. V., Rasmussen L. S. (2013). Is postoperative cognitive dysfunction a risk factor for dementia? A cohort follow-up study. Br. J. Anaesth. 110 Suppl 1, i92–i97. 10.1093/bja/aes466
    1. Tanaka P., Goodman S., Sommer B. R., Maloney W., Huddleston J., Lemmens H. J. (2017). The effect of desflurane versus propofol anesthesia on postoperative delirium in elderly obese patients undergoing total knee replacement: a randomized, controlled, double-blinded clinical trial. J. Clin. Anesth. 39, 17–22. 10.1016/j.jclinane.2017.03.015
    1. Van Der Elst W., Van Boxtel M. P., Van Breukelen G. J., Jolles J. (2007). Assessment of information processing in working memory in applied settings: the paper and pencil memory scanning test. Psychol. Med. 37, 1335–1344. 10.1017/S0033291707000360
    1. Vedel A. G., Holmgaard F., Siersma V., Langkilde A., Paulson O. B., Ravn H. B., et al. . (2019). Domain-specific cognitive dysfunction after cardiac surgery. A secondary analysis of a randomized trial. Acta Anaesthesiol. Scand. 63, 730–738. 10.1111/aas.13343
    1. Willner A. E., Rabiner C. J., Wisoff B. G., Fishman J., Rosen B., Hartstein M., et al. . (1976). Analogy tests and psychopathology at follow-up after open heart surgery. Biol. Psychiatry 11, 687–696. 10.1037/e668292012-505
    1. Willner A. E., Struve F. A. (1970). An analogy test that predicts EEG abnormality. Use with hospitalized psychiatric patients. Arch. Gen. Psychiatry 23, 428–437. 10.1001/archpsyc.1970.01750050044007
    1. Woodhouse J., Heyanka D. J., Scott J., Vincent A., Roebuck-Spencer T., Domboski-Davidson K., et al. . (2013). Efficacy of the ANAM general neuropsychological screening battery (ANAM GNS) for detecting neurocognitive impairment in a mixed clinical sample. Clin. Neuropsychol. 27, 376–385. 10.1080/13854046.2012.762427
    1. Yocum G. T., Gaudet J. G., Teverbaugh L. A., Quest D. O., McCormick P. C., Connolly E. S., Jr., et al. . (2009). Neurocognitive performance in hypertensive patients after spine surgery. Anesthesiology 110, 254–261. 10.1097/ALN.0b013e3181942c7a
    1. Zhang Y., Shan G. J., Zhang Y. X., Cao S. J., Zhu S. N., Li H. J., et al. . (2018). Propofol compared with sevoflurane general anaesthesia is associated with decreased delayed neurocognitive recovery in older adults. Br. J. Anaesth. 121, 595–604. 10.1016/j.bja.2018.05.059

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