Background and Goal of Study: Cognitive impairment predominates in the older population and can have a negative impact on postoperative outcomes. The Montreal Cognitive Assessment (MoCA) is a 30-point assessment that can be completed in 10 minutes, has been well validated in the identification of vascular cognitive impairment, dementia, and mild cognitive impairment (MCI). Our study aimed to evaluate the incidence of in elderly surgical patients and its related outcome.
Materials and Methods: We conducted an observational prospective study after approval by the Institutional ethics committee. Patients aged > 60 years, submitted to elective surgery from May to July 2017 were included. Data collection included comorbidities and medication. The burden of comorbidity was quantified using the Charlson Comorbidity Index. The physiological and operative severity score for the enumeration of mortality and morbidity score (POSSUM) was used to determine operative morbidity and mortality risk. The Quality of Recovery 15-item (QoR-15) was calculated before surgery (T0) and 24 hours after surgery (T1). WHODAS score was used to assess disability T0 and 1month after surgery (M1). The Lawton Instrumental Activities of Daily Living scale (IADL) was used to assess independent living skills. The Health-related Quality of Life (EQ-5D) measure health-related quality of life at 3months follow-up (M3). MoCa was applied before surgery, patients who scored <26 were considered to have MCI. The Mann-Whitney test, Chi-square or Fisher’s exact test were used for comparison.
Results and Discussion: A total of 235 patients were included. The incidence of MCI was 75%. These patients were older (median age 72 vs. 65, p<0.001) had more frequently history of hypertension (p=0.037), diabetes (p=0.005), peripheral vascular disease (p=0.019), cerebrovascular disease (p=0.006), congestive heart failure (p=0.033) and ischaemic heart disease (p=0.026). MCI were more frequently on b-blockers (p=0.002), insulin (p=0.014) and benzodiazepines (p<0,001). MCI patients had a higher median total QoR-15 at T0 (p=0.009) but at T1 the total score was similar. MIC patients had higher median scores of Charlson Comorbidity Index (p=0,006),  WHODAS at T0 (p<0,001) and at M1 (p<0,001), Lawton at T0 (p<0,001) and M1 (p<0,001). MCI patients had more problems at all EQ-5D dimensions at T1 and M3(p<0,001). According to POSSUM, these patients had similar risks of morbidity and mortality.
Conclusions: MCI was common among old patients scheduled for surgery. Patients with MCI were  older, had worst health status prior surgery, more comorbidities, more disability, worse quality of life and more dependency before and after surgery.


09 / Mild cognitive impairment in elderly surgical patients.