Title : A prospective study evaluating the prevalence and risk factors for cognitive impairment in neurosurgical informed consents
Abstract:
Introduction: Neurosurgical patients often experience symptoms that impact cognition, raising the concern patients consenting to surgery do not have the capacity to provide adequate informed consent. The Montreal Cognitive Assessment (MoCA) is a quick 30-point screening tool used to detect mild cognitive impairment (MCI) with excellent specificity and sensitivity. Few studies have explored the effect of MCI on patient education during surgical informed consent processes. This preliminary analysis evaluates how patient demographics, symptoms, and symptom management relate to cognitive impairment and the patient’s capacity to receive proper surgical procedure education.
Methodology: 119 consecutive neurosurgical patients that consented to a surgical procedure at a single institution were approached for the study. Enrolled patients completed a questionnaire pertaining to their demographics, pain, anxiety, medication, and sleeping habits. Patients were then asked to recite their procedure and complete the MoCA. A Memory Index Score (MIS), a 15-point scale specific to memory performance within the MoCA, was also calculated for each participant. Procedure recitation was evaluated on correctly recalling surgery type and operative location. A patient passed the MoCA if they scored higher than 25 and failing the MoCA was indicative of MCI present. While there is no standard threshold for a normal MIS score, higher MIS scores indicate better memory function. Potential risk factors for failing the MoCA were evaluated using the Pearson chi-square test and logistic regression using data collected from the patient demographic questionnaire. The correlation between passing MoCA and correctly reciting procedures was also evaluated using the chi-square test and logistic regression. Differences of means in MoCA and MIS scores between brain and spine patients were performed by t-test analysis. All statistical analyses used an ???? of 0.05.
Results: 68.06% (81/119) of participants passed the MoCA and 66.3% of participants correctly recited their procedure. There was no statistically significant association between failing MoCA and patient age, sex, brain or spine diagnosis, quality of sleep, pain medication use, reported altered concentration due to either pain or sleep, pain score, reported anxiety, and correct procedure recitation (p > 0.05). Brain and spine patients showed no difference in means for MoCA and MIS scores.
Conclusion: Nearly one-third of neurosurgical patients demonstrated neurocognitive deficits and one-third incorrectly recalled surgical procedure details shortly after surgical consent. No risk factors for neurocognitive impairment were identified with current analysis and cohort. Additional enrollment is necessary to better evaluate potential risk factors and to strengthen the statistical power of the results especially in the chi-square tests.
