Validation of The Telephone Interview for Cognitive Status and Montreal Cognitive Assessment against neuropsychological assessment for postoperative cognitive dysfunction in the elderly (The TINMAN study).

Coming years will see increased aging of the Dutch population, subsequently
resulting in more surgery in this group . This is reflected in the recent
guideline of the Dutch Society of Anesthesiology (NVA), advising to screen
elderly preoperative patients for frailty and cognitive impairment.
The incidence of postoperative cognitive dysfunction (POCD) in the elderly
is approximately 25% after one week and 10% after three months. However,
because of poor characterization of the syndrome and resulting lack of
diagnostic criteria, substantial variation exists in reported incidence rates.
Nevertheless, POCD is associated with increased length of hospital stay after
surgery, subsequent cognitive decline and premature death. To date, extensive
and time consuming neuropsychological screening of patients is still the gold
standard for diagnosing POCD. In the literature it has been suggested that
neuropsychological assessment (NPA) should involve multiple domains. Declines
in perception and abstract thinking, learning, memory, attention, executive
functioning and language have all been proposed. Most of these tests require
face-to-face administration, which is not always feasible, particularly in the
follow-up of the elderly. Therefore, a screening tool identifying patients at
risk for POCD would be very useful in the preoperative setting.
The Telephone Interview for Cognitive Status (TICS), was modeled after the
Mini-Mental State Examination (MMSE) and is purported to be a test of global
cognitive functioning. The test has the added benefit of being administered
over telephone. The Montreal Cognitive Assessment (MoCA) is a brief cognitive
screening tool for mild cognitive impairment and has been named as a
potentially suitable tool for diagnosing POCD.

In this study, we aim to validate the TICS and MoCA questionnaires against NPT,
hoping to find a patient friendly and easy to use screening aid for
preoperative evaluation clinics. Thus, aiding shared decision making regarding
the appropriate treatment choices for patients.

We will perform a prospective observational single center cohort study in the
Netherlands with an expected duration of 1 year. The study will be conducted at
the Amsterdam UMC, location Amsterdam.

Neurocognitive function tests:
In all participating subjects we will administer the TICS and MoCA
questionnaire to assess pre- and postoperative cognitive dysfunction. The
preoperative screening will, at the latest, be completed one day before
surgery. The postoperative questionnaires will be administered between 3-8
weeks postoperatively. It takes 5-10 minutes to complete each questionnaire.
The questionnaires are administered over telephone. The burden to the patient
is considered to be low.
The neuropsychological assessment shall consist of 11 standard verbal and
nonverbal tasks that takes between 60 and 90 minutes to complete. NPA will be
undertaken both pre- and approximately one month postoperatively. We shall aim
to combine NPA with other visits to the hospital. If this cannot be arranged,
we will ask patients to come to the Amsterdam UMC, location AMC solely for NPA.
The burden to the patient is considered to be low.
There are no risks associated with participation.