The sensitivity and specificity of statistical rules for diagnosing delayed neurocognitive recovery with Montreal cognitive assessment in elderly surgical patients: A cohort study.

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Tytuł:: The sensitivity and specificity of statistical rules for diagnosing delayed neurocognitive recovery with Montreal cognitive assessment in elderly surgical patients: A cohort study.
Autorzy:: Hu J; Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital.; Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University.
Li CJ; Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital.
Wang BJ; Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital.
Li XY; Department of Biostatics, Peking University First Hospital, Beijing, China.
Mu DL; Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital.
Wang DX; Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital.
Źródło:: Medicine [Medicine (Baltimore)] 2020 Jul 17; Vol. 99 (29), pp. e21193.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins
MeSH Terms:: Mental Status and Dementia Tests/*standards
Neurocognitive Disorders/*diagnosis
Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Humans ; Male ; Mental Status and Dementia Tests/statistics & numerical data ; Middle Aged ; Neurocognitive Disorders/classification ; Neurocognitive Disorders/physiopathology ; Neuropsychological Tests ; ROC Curve ; Reproducibility of Results ; Sensitivity and Specificity
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Entry Date(s):: Date Created: 20200725 Date Completed: 20200803 Latest Revision: 20221005
Update Code:: 20240104
PubMed Central ID:: PMC7373532
DOI:: 10.1097/MD.0000000000021193
PMID:: 32702882
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Delayed neurocognitive recovery (DNR) is common in elderly patients after major noncardiac surgery. This study was designed to investigate the best statistical rule in diagnosing DNR with the Montreal cognitive assessment (MoCA) in elderly surgical patients.This was a cohort study. One hundred seventy-five elderly (60 years or over) patients who were scheduled to undergo major noncardiac surgery were enrolled. A battery of neuropsychological tests and the MoCA were employed to test cognitive function at the day before and on fifth day after surgery. Fifty-three age- and education-matched nonsurgical control subjects completed cognitive assessment with the same instruments at the same time interval. The definition of the international study of postoperative cognitive dysfunction (ISPOCD 1) was adopted as the standard reference for diagnosing DNR. With the MoCA, the following rules were used to diagnose DNR: the cut-off point of ≤26; the 1 standard deviation decline from baseline; the 2 scores decline from baseline; and the Z score of ≥1.96. The sensitivity and specificity as well as the area under receiver operating characteristic curve for the above rules in diagnosis of DNR were calculated.The incidence of DNR was 13.1% (23/175) according to the ISPOCD1 definition. When compared with the standard reference, the 2 scores rule showed the best combination of sensitivity (82.6%, 95% confidence interval [CI] 67.1%-98.1%) and specificity (82.2%, 95% CI 76.2%-88.3%); it also had the largest area under receiver operating characteristic curve (0.824, 95% CI 0.728-0.921, P < .001). The cut-off point rule showed high sensitivity (95.7%) and low specificity (37.5%), whereas the 1 standard deviation and the Z score rules showed low sensitivity (47.8% and 21.7%, respectively) and high specificity (93.4% and 97.3%, respectively).Compared with the ISPOCD1 definition, the 2 scores rule with MoCA had the best combination of sensitivity and specificity to diagnose DNR.

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