A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: A feasibility study.
aging
cognition
cognitive screening
feasibility
perioperative neurocognitive disorder
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
revised:
26
10
2020
received:
14
09
2020
accepted:
21
11
2020
medline:
10
12
2020
pubmed:
10
12
2020
entrez:
9
12
2020
Statut:
ppublish
Résumé
We developed a digital clock drawing test (dCDT), an adaptation of the original pen and paper clock test, that may be advantageous over previous dCDTs in the perioperative environment. We trialed our dCDT on a tablet device in the preoperative period to determine the feasibility of administration in this setting. To assess the clinical utility of this test, we examined the relationship between the performance on the test and compared derived digital clock measures with the 4 A's Test (4AT), a delirium and cognition screening tool. We recruited a sample of 102 adults aged 65 years and over presenting for elective surgery in a single tertiary hospital. Participants completed the 4AT, followed by both command and copy clock conditions of the dCDT. We recorded time-based clock-drawing metrics, alongside clock replications scored using the Montreal Cognitive Assessment (MoCA) clock scoring criteria. The dCDT had an acceptance rate of 99%. After controlling for demographic variables and prior tablet use, regression analyses showed higher 4AT scores were associated with greater dCDT time (seconds) for both command (β = 8.2, P = .020) and copy clocks (β = 12, P = .005) and lower MoCA-based clock scores in both command (OR = 0.19, P = .001) and copy conditions (OR = 0.14, P = .012). The digital clock drawing test is feasible to administer and is highly acceptable to older adults in a preoperative setting. We demonstrated a significant association between both the dCDT time and clock score metrics, with the established 4AT. Our results provide convergent validity of the dCDT in the preoperative setting.
Sections du résumé
BACKGROUND
BACKGROUND
We developed a digital clock drawing test (dCDT), an adaptation of the original pen and paper clock test, that may be advantageous over previous dCDTs in the perioperative environment. We trialed our dCDT on a tablet device in the preoperative period to determine the feasibility of administration in this setting. To assess the clinical utility of this test, we examined the relationship between the performance on the test and compared derived digital clock measures with the 4 A's Test (4AT), a delirium and cognition screening tool.
METHODS
METHODS
We recruited a sample of 102 adults aged 65 years and over presenting for elective surgery in a single tertiary hospital. Participants completed the 4AT, followed by both command and copy clock conditions of the dCDT. We recorded time-based clock-drawing metrics, alongside clock replications scored using the Montreal Cognitive Assessment (MoCA) clock scoring criteria.
RESULTS
RESULTS
The dCDT had an acceptance rate of 99%. After controlling for demographic variables and prior tablet use, regression analyses showed higher 4AT scores were associated with greater dCDT time (seconds) for both command (β = 8.2, P = .020) and copy clocks (β = 12, P = .005) and lower MoCA-based clock scores in both command (OR = 0.19, P = .001) and copy conditions (OR = 0.14, P = .012).
CONCLUSION
CONCLUSIONS
The digital clock drawing test is feasible to administer and is highly acceptable to older adults in a preoperative setting. We demonstrated a significant association between both the dCDT time and clock score metrics, with the established 4AT. Our results provide convergent validity of the dCDT in the preoperative setting.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
473-480Informations de copyright
© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Références
Dall T, Reynolds R, Jones K, Chakrabarti R, Iacobucci W. 2019 update: the complexities of physician supply and demand: projections from 2017 to 2032. 2019.
Partridge JSL, Dhesi JK, Cross JD, et al. The prevalence and impact of undiagnosed cognitive impairment in older vascular surgical patients. J Vasc Surg. 2014;60:1002-1011.
Bilotta F, Lauretta MP, Borozdina A, Mizikov VM, Rosa G. Postoperative delirium: risk factors, diagnosis and perioperative care. Minerva Anestesiol. 2013;79:1066-1076.
Evered L, Silbert B, Scott DA. Pre-existing cognitive impairment and post-operative cognitive dysfunction: should we be talking the same language? Int Psychogeriatr. 2016;28:1053-1055.
Evered LA, Silbert BS. Postoperative Cognitive dysfunction and noncardiac surgery. Anest Analg. 2018;127:496-505.
Culley DJ, Flaherty D, Reddy S, et al. Preoperative cognitive stratification of older elective surgical patients: a cross-sectional study. Anest Analg. 2016;123:186-192.
Silbert B, Evered L, Scott DA, et al. Preexisting cognitive impairment is associated with postoperative cognitive dysfunction after hip joint replacement surgery. Anesthesiol. 2015;122:1224-1234.
Culley DJ, Flaherty D, Fahey MC, et al. Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients. Anesthesiol. 2017;127:765-774.
Arias F, Bursian AC, Sappenfield JW, Price CE. Delirium history and preoperative mild neurocognitive disorder: an opportunity for multidisciplinary patient-centered care. Am J Case Rep. 2018;19:1324-1328.
Arias F, Wiggins M, Urman RD, et al. Rapid in-person cognitive screening in the preoperative setting: test considerations and recommendations from the society for perioperative assessment and quality improvement (SPAQI). J Clin Anesth. 2020;62:109724.
Seitz DP, Chan CCH, Newton HT, et al. Mini-Cog for the diagnosis of Alzheimer's disease dementia and other dementias within a primary care setting. Cochrane Database Syst Rev. 2018;2:CD011415.
MacLullich AMJ, Shenkin SD, Goodacre S, et al. The 4 'A's test for detecting delirium in acute medical patients: a diagnostic accuracy study. Health Technol Assess. 2019;23:1-194.
Saller T, MacLullich AMJ, Schäfer ST, et al. Screening for delirium after surgery: validation of the 4 A's test (4AT) in the post-anaesthesia care unit. Anaesthesia. 2019;74:1260-1266.
Amini S, Crowley S, Hizel L, et al. Feasibility and rationale for incorporating frailty and cognitive screening protocols in a preoperative anesthesia clinic. Anest Analg. 2019;129(3):830-838.
Bellelli G, Morandi A, Davis DH, et al. Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing. 2014;43:496-502.
Schofield I, Stott DJ, Tolson D, McFadyen A, Monaghan J, Nelson D. Screening for cognitive impairment in older people attending accident and emergency using the 4-item abbreviated mental test. Eur J Emerg Med. 2010;17:340-342.
O'Regan N, Maughan K, Liddy N, et al. Five short screening tests in the detection of prevalent delirium: diagnostic accuracy and performance in different neurocognitive subgroups. Int J Geriatr Psychiatry. 2017;32:1440-1449.
Cosentino S, Jefferson A, Chute DL, Kaplan E, Libon DJ. Clock drawing errors in dementia: neuropsychological and neuroanatomical considerations. Cogn Behav Neurol. 2004;17:74-84.
Kaplan E. The process approach to neuropsychological assessment of psychiatric patients. J Neuropsy Clin Neurosci. 1990;2:72-87.
Libon DJ, Malamut BL, Swenson R, Sands LP, Cloud BS. Further analyses of clock drawings among demented and nondemented older subjects. Arch Clin Neuropsychol. 1996;11:193-205.
Price CC, Cunningham H, Coronado N, et al. Clock drawing in the montreal cognitive assessment: recommendations for dementia assessment. Dement Geriatr Cogn Disord. 2011;31:179-187.
Muller S, Herde L, Preische O, et al. Diagnostic value of digital clock drawing test in comparison with CERAD neuropsychological battery total score for discrimination of patients in the early course of Alzheimer's disease from healthy individuals. Sci Rep. 2019;9:10.
Hizel LP, Warner ED, Wiggins ME, et al. Clock drawing performance slows for older adults after total knee replacement surgery. Anest Analg. 2019;129:212-219.
Fazeli PL, Ross LA, Vance DE, Ball K. The relationship between computer experience and computerized cognitive test performance among older adults. J Gerontol B Psychol Sci Soc Sci. 2013;68:337-346.
Iverson GL, Brooks BL, Ashton VL, Johnson LG, Gualtieri CT. Does familiarity with computers affect computerized neuropsychological test performance? J Clin Exp Neuropsychol. 2009;31:594-604.
Wallace SE, Donoso Brown EV, Simpson RC, et al. A comparison of electronic and paper versions of the montreal cognitive assessment. Alzheimer Dis Assoc Disord. 2019;33:272-278.
Monsch RJ, Burckhardt AC, Berres M, et al. Development of a novel self-administered cognitive assessment tool and normative data for older adults. J Neurosurg Anesthesiol. 2019;31:218-226.
Sahakian BJ, Owen AM. Computerized assessment in neuropsychiatry using CANTAB: discussion paper. J R Soc Med. 1992;85:399-402.
Westerman R, Darby DG, Maruff P, Collie A. Computer-assisted cognitive function assessment of pilots. ADF Health. 2001;2:29-36.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344-349.
Bowen DJ, Kreuter M, Spring B, et al. How we design feasibility studies. Am J Prev Med. 2009;36:452-457.
Standards NSaQHS. User guide for health service organisations providing care for patients with cognitive impairment or at risk of delirium. Level 5, 255 Elizabeth Street, Sydney NSW 2000: the Australian Commission on Safety and Quality in Health Care, 2019.
Nasreddine ZS, Phillips NA, Bedirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695-699.
Freedman M, Leach L, Kaplan E, Shulman K, Delis DC. Clock drawing: A neuropsychological analysis: Oxford University Press. USA: 1994.
Zhào H, Wei W, Do EY, Huang Y. Assessing performance on digital clock drawing test in aged patients with cerebral small vessel disease. Front Neurol. 2019;10:1259.
Shenkin SD, Fox C, Goodacre S, et al. Utility of the 4AT rapid assessment instrument in assessment of delirium and cognitive impairment in acute care. Age Ageing. 2019;48:i38.
Collie A, Darekar A, Weissgerber G, et al. Cognitive testing in early-phase clinical trials: development of a rapid computerized test battery and application in a simulated Phase I study. Contemp Clin Trials. 2007;28:391-400.
O'Gara BP, Mueller A, Gasangwa DVI, et al. Prevention of early postoperative decline: a randomized, controlled feasibility trial of perioperative cognitive training. Anesth Analg. 2020;130:586-595.
Apple. (2020) Cleaning Apple Products. [www document] https://support.Apple.com/en-au/HT204172#ipads [accessed on July 2020]
Müller S, Preische O, Heymann P, Elbing U, Laske C. Increased diagnostic accuracy of digital vs. conventional clock drawing test for discrimination of patients in the early course of Alzheimer's disease from cognitively healthy individuals. Front Aging Neurosci. 2017;9:101-201.
Dion C, Arias F, Amini S, et al. Cognitive correlates of digital clock drawing metrics in older adults with and without mild cognitive impairment. J Alzheimers Dis. 2020;75:73-83.
Cohen J, Penney DL, Davis R, et al. Digital Clock Drawing: differentiating "thinking" versus "doing" in younger and older adults with depression. J Int Neuropsychol Soc. 2014;20:920-928.