Validity of a screening tool for detecting subtle cognitive impairment in the middle-aged and elderly.

The present study tested 121 middle-aged and elderly community-dwelling individuals on the computer-based Subtle Cognitive Impairment Test (SCIT) and compared their performance with that on several neuropsychological tests. The SCIT had excellent internal consistency, as demonstrated by a high split-half reliability measure (0.88-0.93). Performance on the SCIT was unaffected by the confounding factors of sex, education level, and mood state. Many participants demonstrated impaired performance on one or more of the neuropsychological tests (Controlled Oral Word Association Task, Rey Auditory and Verbal Learning Task, Grooved Pegboard [GP], Complex Figures). Performance on SCIT subtests correlated significantly with performance on many of the neuropsychological subtests, and the best and worst performing quartiles on the SCIT subtest discriminated between good and poor performers on other subtests, collectively indicating concurrent validity of the SCIT. Principal components analysis indicated that SCIT performance does not cluster with performance on most of the other cognitive tests, and instead is associated with decision-making efficacy, and processing speed and efficiency. Thus, the SCIT is responsive to the processes that underpin multiple cognitive domains, rather than being specific for a single domain. Since the SCIT is quick and easy to administer, and is well tolerated by the elderly, it may have utility as a screening tool for detecting cognitive impairment in middle-aged and elderly populations.

Effects on cognition of conventional and robotically assisted cardiac valve operation.

BACKGROUND: The effect of valve surgical procedures on cognition was investigated in patients undergoing conventional or robotically assisted techniques. The confounding factors of surgical procedure, mood state, preexisting cognitive impairment, and repeated experience with cognitive tests were controlled for. METHODS: Patients undergoing conventional valve procedures (n = 15), robotically assisted valve procedures (n = 15), and thoracic surgical procedures (n = 15), along with a nonsurgical control group (n = 15) were tested preoperatively, 1 week after operation, and 8 weeks after operation by use of a battery of cognitive tests and a mood state assessment. Surgical group data were normalized against data from the nonsurgical control group before statistical analysis. RESULTS: Patients undergoing conventional valve procedures performed worse than those undergoing robotically assisted valve procedures on every subtest before operation, and this disadvantage persisted after operation. Age and premorbid intelligence quotient were significantly associated with performance on several cognitive subtests. Anxiety, depression, and stress were not associated with impaired cognitive performance in the surgical groups after operation. A week after operation, patients undergoing conventional valve procedures performed worse on the cognitive tests that had a motor component, which may reflect discomfort caused by the sternotomy. Patients undergoing robotically assisted valve procedures were significantly less impaired on information processing tasks 1 week after operation when compared with those undergoing conventional valve procedures. The majority of patients who were impaired 1 week after operation recovered to preoperation levels within 8 weeks. CONCLUSIONS: The robotically assisted valve surgical procedure results in more rapid recovery of performance on cognitive tests. However, regardless of the type of surgical intervention, the prospect of a recovery of cognitive performance to preoperative levels is high.

Recovery of cognitive function after coronary artery bypass graft operations.

BACKGROUND: The effect of coronary artery bypass grafting (CABG) operations on cognition was examined after controlling for the operation, emotional state, preexisting cognitive impairment, and repeated experience with cognitive tests. METHODS: On-pump CABG patients (n=16), thoracic surgical patients (n=15), and a nonsurgical control group (n=15) were tested preoperatively, and at 1 and 8 weeks postoperatively, using a battery of cognitive tests and an emotional state assessment. Patient groups were similar in age, sex, level of education, and premorbid intelligence quotient score. Surgical group data were normalized against data from the nonsurgical control group before statistical analysis. RESULTS: CABG patients performed worse on every subtest before the operation, and this disadvantage persisted after the operation. Anxiety, depression, and stress were associated with impaired cognitive performance in the surgical groups 1 week after the operation: 44% of CABG patients and 33% of surgical control patients were significantly impaired; yet, by 8 weeks, nearly all patients had recovered to preoperative levels, with 25% of CABG and 13% of surgical control patients improving beyond their preoperative performance. CONCLUSIONS: Stress, anxiety, and depression impair cognitive performance in association with CABG and thoracic operations. Most patients recover to, or exceed, preoperative levels of cognition within 8 weeks. Thus, after controlling for nonsurgical factors, the prospects of a tangible improvement in cognition after CABG are high.