Response to Paul Regal

Abstract

To the Editor: We appreciate this opportunity to clarify important aspects of our study1 in response to the letter from Dr. Paul Regal.2 First, we would like to emphasize that severe hearing impairment was an exclusionary criteria for the Successful Aging After Elective Surgery (SAGES) Study. Some study participants use hearing aids and were encouraged to use them during the interviews. In addition, the interviewers were carefully trained in communicating with older adults with hearing impairment and had portable amplifiers available for use as needed. Because baseline dementia was an exclusionary criterion for this study, we followed a careful, multistep process to exclude dementia, as follows: self- or clinician report of a dementia diagnosis, medical record diagnosis of dementia, or a baseline (preoperative) Modified Mini-Mental State (3MS) score of less than 69 (or its education-adjusted equivalent).3 Individuals were also excluded for possible dementia after neuropsychological testing and clinical adjudication of all study results by an expert panel. The Confusion Assessment Method (CAM) was used only for identification of delirium in the study and not as part of the dementia diagnosis process or for the course (improvement, worsening) or trajectory of postoperative cognitive decline. Long-term cognitive decline in this study is measured using the complete neuropsychological test battery, which is completed at 1, 2, 6, and 12 months and every 6 months thereafter. One of our primary outcome measures for cognitive functioning is our composite measure based on the neuropsychological test battery, which we refer to as our General Cognitive Performance score.4, 5 Although no studies have been published with this database examining reversibility of delirium, the SAGES Study has a wide range of delirium instruments to use for this purpose, including cognitive screening tests, digit spans, CAM, CAM-Severity, Delirium Symptom Interview, and Memorial Delirium Assessment Scale.3 We believe this study provides a valuable resource for examination of risk factors for and outcomes of postoperative delirium in older persons. Conflict of Interest: Neither of the authors report any conflicts of interest. Both authors fully disclose they have no financial interests, activities, relationships, and affiliations. The coauthors also declare they have no potential conflicts in the 3 years before submission of this manuscript. Supported by Grant P01AG031720 (SKI) from the National Institute on Aging. Author Contributions: Both authors contributed to this paper. Sponsor's Role: None.