Cognitive monitoring in planned arthroplasty surgery study

Abstract

South West Anaesthesia Research Matrix, UK South West Peninsula Deanery, South West Peninsula, UK A decline in cognitive function is common1 and sometimes permanent after a major surgery in the elderly. It is uncertain what causes the change, whether a similar decline might occur without surgery, and who is at risk. The current literature lacks an accurate picture of preoperative cognitive trajectories and trajectory in older people who do not have surgery.2,3 Our aim was to assess the feasibility of serial remote monitoring of cognition with an online tool (CogTrack Wesnes Cognition Ltd, London) in elderly patients undergoing planned arthroplasty surgery and matched non-surgical controls. Our primary care and anaesthetic trainee research networks will work in collaboration with patients, industry, and cognition experts. Feasibility study testing of a prospective observational methodology at two secondary care sites and two primary care sites. Serial cognitive testing will be performed with CogTrack on 150 surgical patients and 150 matched non-surgical controls over an 11-week window incorporating the surgical episode. The primary outcome measure is feasibility. The secondary outcome measures include CogTrack scores and prevalence of factors, which may impact on cognition. The patients were involved in refining outcome measures and will contribute throughout. Feasibility data, including number of patients approached, recruited, declining, and withdrawing, will be collected, and information about IT accessibility and completion rates of assessments. Summary statistics will be conducted on CogTrack data for cases and control groups, and plots constructed to demonstrate trajectory of scores over the 11-week study period. Mixed-model srepeated measures analysis will be performed to assess the effects of exposure to arthroplasty and adjust for candidate covariates. Our aim, in a future multicentre study, is to track the cognitive trajectories of a large number of operated cases and matched controls over a long time period. Arthroplasty surgery is performed very commonly, and on an increasingly ageing population, aiming to improve functional capacity. Conversely, permanently altered cognition could impact on patients’ quality of life. Clinical research underpins shared decision-making with patients. 1.Moller JT, Cluitmans P, Rasmussen LS, et al. Lancet 1998; 351: 857–612.Evered LA. Anesth Analg 2017; 124: 1036–83.Scott JE, Mathias JL, Kneebone AC. J Arthroplasty 2014; 29: 261–7.e1