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Prevalence of pre-operative undiagnosed cognitive impairment and its association with handgrip strength, oral hygiene, and nutritional status in older elective surgical patients in Japan

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Abstract

Purpose

Preoperative cognitive impairment is a significant factor influencing post-operative delirium. We have been performing routine pre-operative comprehensive assessments, including evaluation of cognitive function, handgrip strength, oral hygiene, and nutritional status, in patients aged ≥ 65 years since April 2021. This study aimed to examine the completion rate of pre-operative comprehensive assessment and assess the prevalence of pre-operative undiagnosed cognitive impairment.

Methods

In this prospective observational study including patients aged ≥ 65 years scheduled for elective surgery with general or regional anesthesia, cognitive impairment was defined as a Mini-Cog score ≤ 2, and its associations with handgrip strength, oral hygiene, and nutritional status were evaluated. Oral hygiene and nutritional status were assessed using an oral frailty self-checklist and the Mini Nutritional Assessment-Short Form, respectively. The incidence of pre-operative undiagnosed cognitive impairment was estimated, and its associated factors were explored with multiple logistic regression.

Results

Among 331 eligible patients, the completion rate was 97.7% (305/312). The mean age was 74.8 years, and 13.1% (40/305) (95% confidence interval [CI], 9.7–17.3%) of the patients had pre-operative undiagnosed cognitive impairment. Multiple logistic regression revealed that handgrip strength (odds ratio [OR] = 0.94, 95%CI = 0.89–0.99) and oral frailty self-checklist score (OR = 1.19, 95%CI = 1.02–1.40) were associated with pre-operative undiagnosed cognitive impairment, while the Mini Nutritional Assessment-Short Form score was not significantly associated (OR = 0.97, 95%CI = 0.82–1.14).

Conclusions

Preoperative comprehensive assessment was feasible. The prevalence of pre-operative undiagnosed cognitive impairment was 13%, and poor handgrip strength and worse oral hygiene were significantly associated factors.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Anesthesiology, Akashi Medical Center, Akashi, Japan

    Shohei Nakatani

  2. Department of Anesthesiology, Nara Medical University, Kashihara, Shijo 840, Nara, 634-8522, Japan

    Shohei Nakatani, Mitsuru Ida, Kayo Uyama, Yuki Kinugasa & Masahiko Kawaguchi

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  1. Shohei Nakatani
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  2. Mitsuru Ida
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Contributions

SN: study concept and design, data collection. MI: study coordinator, study concept and design, interpretation of data, writing of manuscript. KU: data collection. YK: data analysis. MK: interpretation of data, and revision of manuscript. All authors: critical review of manuscript, approval of final version.

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Correspondence to Mitsuru Ida.

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Nakatani, S., Ida, M., Uyama, K. et al. Prevalence of pre-operative undiagnosed cognitive impairment and its association with handgrip strength, oral hygiene, and nutritional status in older elective surgical patients in Japan. J Anesth 37, 64–71 (2023). https://doi.org/10.1007/s00540-022-03133-9

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  • DOI: https://doi.org/10.1007/s00540-022-03133-9

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