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The New Frontier of Perioperative Cognitive Medicine for Alzheimer’s Disease and Related Dementias

Neurotherapeutics volume 19, pages 132–142 (2022)Cite this article

Abstract

This is a review of preoperative cognitive assessment and other healthcare gaps in the care of older adults at risk for Alzheimer’s disease and related dementias (ADRD) who have elected surgery with anesthesia. It summarizes concerns regarding ADRD perioperative healthcare, perioperative cognitive, and neuronal domains of vulnerability. It also offers a plan for phased preoperative cognitive screening and perioperative cognitive intervention opportunities. An argument is made for why medical professionals in the perioperative setting need fundamental training in cognitive-behavioral principles, an understanding of neurodegenerative diseases of aging, and an appreciation of the immediate and long-term medical risks for such patients undergoing anesthesia. The author’s goal is to encourage readers to consider perioperative cognitive medicine as a new frontier for generating evidence-based care approaches for at-risk older adults with neurodegenerative disorders who require procedures with anesthesia.

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References

  1. WHO. Aging and Health. 2021. https://www.who.int/en/news-room/fact-sheets/detail/ageing-and-health2021.

  2. Vincent GK, Velkoff VA. The next four decades. The older population in the United States: 2010 to 2050. In: Bureau USC, editor. Washington, DC. 2010.

  3. Association As. Alzheimer’s Disease Facts and Figures. Alzheimers Dement. 2021;17.

  4. Williams SN, Wolford ML, Bercovitz A. Hospitalization for total knee replacement among inpatients aged 45 and over: 2000–2010. In: Services USDoHaH, editor. Centers for Disease Control and Prevention: NCHS Data Brief. 2015.

  5. Amini S, Crowley S, Hizel L, Arias F, Libon DJ, Tighe P, et al. Feasibility and rationale for incorporating frailty and cognitive screening protocols in a preoperative anesthesia clinic. Anesth Analg. 2019;129(3):830–8.

    PubMed  PubMed Central  Article  Google Scholar 

  6. Culley DJ, Flaherty D, Reddy S, Fahey MC, Rudolph J, Huang CC, et al. Preoperative cognitive stratification of older elective surgical patients: a cross-sectional study. Anesth Analg. 2016;123(1):186–92.

    PubMed  PubMed Central  Article  Google Scholar 

  7. Silbert BS, Scott DA, Evered LA, Lewis MS, Maruff PT. Preexisting cognitive impairment in patients scheduled for elective coronary artery bypass graft surgery. Anesth Analg. 2007;104(5):1023–8, tables of contents.

  8. Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA. Alzheimer disease in the US population: prevalence estimates using the 2000 census. Arch Neurol. 2003;60(8):1119–22.

    PubMed  Article  Google Scholar 

  9. Arias F, Riverso M, Levy SA, Armstrong R, Estores DS, Tighe P, et al. Pilot study: neurocognitive disorders and colonoscopy in older adults. Anesth Analg. 2019;129(3):e89–93.

    PubMed  PubMed Central  Article  Google Scholar 

  10. de Gelder J, Lucke JA, de Groot B, Fogteloo AJ, Anten S, Heringhaus C, et al. Predictors and outcomes of revisits in older adults discharged from the emergency department. J Am Geriatr Soc. 2018;66(4):735–41.

    PubMed  Article  Google Scholar 

  11. Culley DJ, Flaherty D, Fahey MC, Rudolph JL, Javedan H, Huang CC, et al. Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients. Anesthesiology. 2017;127(5):765–74.

    PubMed  Article  Google Scholar 

  12. Fick DM, Agostini JV, Inouye SK. Delirium superimposed on dementia: a systematic review. J Am Geriatr Soc. 2002;50(10):1723–32.

    PubMed  Article  Google Scholar 

  13. Fick DM, Kolanowski AM, Waller JL, Inouye SK. Delirium superimposed on dementia in a community-dwelling managed care population: a 3-year retrospective study of occurrence, costs, and utilization. J Gerontol A Biol Sci Med Sci. 2005;60(6):748–53.

    PubMed  Article  Google Scholar 

  14. Morandi A, Davis D, Bellelli G, Arora RC, Caplan GA, Kamholz B, et al. The diagnosis of delirium superimposed on dementia: an emerging challenge. Journal of the American Medical Directors Association. 2016.

  15. Morandi A, Davis D, Fick DM, Turco R, Boustani M, Lucchi E, et al. Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients. J Am Med Dir Assoc. 2014;15(5):349–54.

    PubMed  PubMed Central  Article  Google Scholar 

  16. Price CC, Garvan C, Hizel LP, Lopez MG, Billings FTt. Delayed recall and working memory mmse domains predict delirium following cardiac surgery. J Alzheimers Dis. 2017;59(3):1027–35.

  17. Wiggins ME, Dion C, Formanski E, Davoudi A, Amini S, Heilman KM, et al. Proof of concept: digital clock drawing behaviors prior to transcatheter aortic valve replacement may predict length of hospital stay and cost of care. Explor Med. 2021;2:110–21.

    PubMed  PubMed Central  Google Scholar 

  18. Zietlow KE, Wong S, McDonald SR, Colon-Emeric C, Cassas C, Lagoo-Deenadayalan S, et al. Perioperative Optimization of Senior Health (POSH): a descriptive analysis of cancelled surgery. World J Surg. 2021;45(1):109–15.

    PubMed  Article  Google Scholar 

  19. Evered L, Scott DA, Silbert B. Cognitive decline associated with anesthesia and surgery in the elderly: does this contribute to dementia prevalence? Curr Opin Psychiatry. 2017;30(3):220–6.

    PubMed  Article  Google Scholar 

  20. Goldberg TE, Chen C, Wang Y, Jung E, Swanson A, Ing C, et al. Association of delirium with long-term cognitive decline: a meta-analysis. JAMA Neurol. 2020;77(11):1373–81.

    PubMed  Article  Google Scholar 

  21. Racine AM, Touroutoglou A, Abrantes T, Wong B, Fong TG, Cavallari M, et al. Older patients with Alzheimer’s disease-related cortical atrophy who develop post-operative delirium may be at increased risk of long-term cognitive decline after surgery. J Alzheimers Dis. 2020;75(1):187–99.

    PubMed  PubMed Central  Article  Google Scholar 

  22. Gottesman RF, Grega MA, Bailey MM, Pham LD, Zeger SL, Baumgartner WA, et al. Delirium after coronary artery bypass graft surgery and late mortality. Ann Neurol. 2010;67(3):338–44.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth. 2020;125(4):492–504.

    PubMed  Article  Google Scholar 

  24. Aminoff MJ, Christine CW, Friedman JH, Chou KL, Lyons KE, Pahwa R, Bloem BR, Parashos SA, Price CC, Malaty IA, Iansek R, Bodis-Wollner I, Suchowersky O, Oertel WH, Zamudio J, Oberdorf J, Schmidt P, Okun MS. National Parkinson Foundation Working Group on Hospitalization in Parkinson's Disease. Management of the hospitalized patient with Parkinson's disease: current state of the field and need for guidelines. Parkinsonism Relat Disord. 2011 Mar;17(3):139–45. https://doi.org/10.1016/j.parkreldis.2010.11.009. Epub 2010 Dec 14. PMID: 21159538; PMCID: PMC3070297.

  25. Enemark M, Midttun M, Winge K. Evaluating outcomes for older patients with Parkinson’s disease or dementia with Lewy bodies who have been hospitalised for hip fracture surgery: potential impact of drug administration. Drugs Aging. 2017;34(5):387–92.

    PubMed  Article  Google Scholar 

  26. Newman JM, Sodhi N, Dalton SE, Khlopas A, Newman RP, Higuera CA, et al. Does Parkinson disease increase the risk of perioperative complications after total hip arthroplasty? A nationwide database study J Arthroplasty. 2018;33(7S):S162–6.

    PubMed  Article  Google Scholar 

  27. Jamsen E, Puolakka T, Peltola M, Eskelinen A, Lehto MU. Surgical outcomes of primary hip and knee replacements in patients with Parkinson's disease: a nationwide registry-based case-controlled study. Bone Joint J. 2014;96-B(4):486–91.

  28. Greene NH, Attix DK, Weldon BC, Smith PJ, McDonagh DL, Monk TG. Measures of executive function and depression identify patients at risk for postoperative delirium. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2009;110(4):788–95.

  29. Price CC, Pereira DB, Andre R, Garvan CW, Nguyen P, Herman M, et al. Prospective pilot investigation: presurgical depressive symptom severity and anesthesia response in women undergoing surgery for gynecologic mass removal. 2015;22(4):521–9.

    Google Scholar 

  30. Smith PJ, Attix DK, Weldon BC, Greene NH, Monk TG. Executive function and depression as independent risk factors for postoperative delirium. Anesthesiology. 2009;110(4):781–7.

    PubMed  Article  Google Scholar 

  31. Lin HS, Peel NM, Hubbard RE. Baseline Vulnerability and Inpatient Frailty Status in Relation to Adverse Outcomes in a Surgical Cohort. J Frailty Aging. 2016;5(3):180–2.

    CAS  PubMed  Google Scholar 

  32. Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157.

    PubMed  PubMed Central  Article  Google Scholar 

  33. Goto T, Yoshitake A, Baba T, Shibata Y, Sakata R, Uozumi H. Cerebral ischemic disorders and cerebral oxygen balance during cardiopulmonary bypass surgery: preoperative evaluation using magnetic resonance imaging and angiography. Anesth Analg. 1997;84(1):5–11.

    CAS  PubMed  Article  Google Scholar 

  34. Giovannetti T, Price CC, Fanning M, Messe S, Ratcliffe SJ, Lyon A, et al. Cognition and cerebral infarction in older adults after surgical aortic valve replacement. Ann Thorac Surg. 2019;107(3):787–94.

    PubMed  Article  Google Scholar 

  35. Price CC, Tanner JJ, Schmalfuss I, Garvan CW, Gearen P, Dickey D, Heilman K, McDonagh DL, Libon DJ, Leonard C, Bowers D, Monk TG. A pilot study evaluating presurgery neuroanatomical biomarkers for postoperative cognitive decline after total knee arthroplasty in older adults. Anesthesiology. 2014 Mar;120(3):601–13. https://doi.org/10.1097/ALN.0000000000000080. PMID: 24534857; PMCID: PMC3930070.

  36. Greene NH, Attix DK, Weldon BC, Smith PJ, McDonagh DL, Monk TG. Measures of executive function and depression identify patients at risk for postoperative delirium. Anesthesiology. 2009;110(4):788–95.

    PubMed  Article  Google Scholar 

  37. Price CC, Garvan CW, Monk TG. Type and severity of cognitive decline in older adults after noncardiac surgery. Anesthesiology. 2008 Jan;108(1):8–17. https://doi.org/10.1097/01.anes.0000296072.02527.18. PMID: 18156877; PMCID: PMC2911011.

    PubMed  Article  Google Scholar 

  38. Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998;351(9106):857–61.

  39. Monk TG, Weldon BC, Garvan CW, Dede DE, van der Aa MT, Heilman KM, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108(1):18–30.

    PubMed  Article  Google Scholar 

  40. Selnes OA, Grega MA, Borowicz LM, Jr., Royall RM, McKhann GM, Baumgartner WA. Cognitive changes with coronary artery disease: a prospective study of coronary artery bypass graft patients and nonsurgical controls. Ann Thorac Surg. 2003;75(5):1377–84; discussion 84–6.

  41. Racine AM, Fong TG, Travison TG, Jones RN, Gou Y, Vasunilashorn SM, et al. Alzheimer’s-related cortical atrophy is associated with postoperative delirium severity in persons without dementia. Neurobiol Aging. 2017;59:55–63.

    PubMed  PubMed Central  Article  Google Scholar 

  42. Hernaiz Alonso C, Tanner JJ, Wiggins ME, Sinha P, Parvataneni HK, Ding M, et al. Proof of principle: Preoperative cognitive reserve and brain integrity predicts intra-individual variability in processed EEG (Bispectral Index Monitor) during general anesthesia. PLoS One. 2019;14(5):e0216209.

  43. Tanner JJ, Amin M, Hardcastle C, Parvataneni H, Vaillancourt DE, Mareci TH, et al. Better brain and cognition prior to surgery is associated with elevated postoperative brain extracellular free-water in older adults. Front Aging Neurosci. 2019;11:117.

    PubMed  PubMed Central  Article  Google Scholar 

  44. Huang H, Tanner J, Parvataneni H, Rice M, Horgas A, Ding M, et al. Impact of total knee arthroplasty with general anesthesia on brain networks: cognitive efficiency and ventricular volume predict functional connectivity decline in older adults. J Alzheimers Dis. 2018;62(1):319–33.

    PubMed  PubMed Central  Article  Google Scholar 

  45. Browndyke JN, Berger M, Harshbarger TB, Smith PJ, White W, Bisanar TL, et al. Resting-state functional connectivity and cognition after major cardiac surgery in older adults without preoperative cognitive impairment: preliminary findings. J Am Geriatr Soc. 2017;65(1):e6–12.

    PubMed  Article  Google Scholar 

  46. Hardcastle C, Huang H, Crowley S, Tanner J, Hernaiz C, Rice M, et al. Mild cognitive impairment and decline in resting state functional connectivity after total knee arthroplasty with general anesthesia. J Alzheimers Dis. 2019;69(4):1003–18.

    PubMed  PubMed Central  Article  Google Scholar 

  47. Hudetz AG. General anesthesia and human brain connectivity. Brain Connect. 2012;2(6):291–302.

    PubMed  PubMed Central  Article  Google Scholar 

  48. Stamatakis EA, Adapa RM, Absalom AR, Menon DK. Changes in resting neural connectivity during propofol sedation. PLoS One. 2010;5(12):e14224.

  49. Goldman-Rakic PS. Regional and cellular fractionation of working memory. Proc Natl Acad Sci U S A. 1996;93(24):13473–80.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  50. Pratico C, Quattrone D, Lucanto T, Amato A, Penna O, Roscitano C, et al. Drugs of anesthesia acting on central cholinergic system may cause post-operative cognitive dysfunction and delirium. Med Hypotheses. 2005;65(5):972–82.

    CAS  PubMed  Article  Google Scholar 

  51. Drevets WC. Neuroimaging and neuropathological studies of depression: implications for the cognitive-emotional features of mood disorders. Curr Opin Neurobiol. 2001;11(2):240–9.

    CAS  PubMed  Article  Google Scholar 

  52. Bliss TV, Collingridge GL, Kaang BK, Zhuo M. Synaptic plasticity in the anterior cingulate cortex in acute and chronic pain. Nat Rev Neurosci. 2016;17(8):485–96.

    CAS  PubMed  Article  Google Scholar 

  53. Baranov D, Bickler PE, Crosby GJ, Culley DJ, Eckenhoff MF, Eckenhoff RG, et al. Consensus statement: First International Workshop on Anesthetics and Alzheimer’s disease. Anesth Analg. 2009;108(5):1627–30.

    PubMed  PubMed Central  Article  Google Scholar 

  54. Silbert B, Evered L, Scott DA, Maruff P. Anesthesiology must play a greater role in patients with Alzheimer’s disease. Anesth Analg. 2011;112(5):1242–5.

    PubMed  Article  Google Scholar 

  55. Bohnen NI, Albin RL. The cholinergic system and Parkinson disease. Behav Brain Res. 2011;221(2):564–73.

    CAS  PubMed  Article  Google Scholar 

  56. Satz P. Brain reserve capacity on symptom onset after brain injury: a formulation and review of evidence for threshold theory. Neuropsychology. 1993;7(3):273–95.

    Article  Google Scholar 

  57. Vemuri P, Lesnick TG, Przybelski SA, Knopman DS, Machulda M, Lowe VJ, et al. Effect of intellectual enrichment on AD biomarker trajectories: longitudinal imaging study. Neurology. 2016;86(12):1128–35.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  58. Carvalho DZ, St Louis EK, Boeve BF, Mielke MM, Przybelski SA, Knopman DS, et al. Excessive daytime sleepiness and fatigue may indicate accelerated brain aging in cognitively normal late middle-aged and older adults. Sleep Med. 2017;32:236–43.

    PubMed  Article  Google Scholar 

  59. Carvalho DZ, St Louis EK, Knopman DS, Boeve BF, Lowe VJ, Roberts RO, et al. Association of excessive daytime sleepiness with longitudinal beta-amyloid accumulation in elderly persons without dementia. JAMA Neurol. 2018;75(6):672–80.

    PubMed  PubMed Central  Article  Google Scholar 

  60. Brown BM, Sohrabi HR, Taddei K, Gardener SL, Rainey-Smith SR, Peiffer JJ, et al. Habitual exercise levels are associated with cerebral amyloid load in presymptomatic autosomal dominant Alzheimer’s disease. Alzheimers Dement. 2017;13(11):1197–206.

    PubMed  PubMed Central  Article  Google Scholar 

  61. Xie Z, Culley DJ, Dong Y, Zhang G, Zhang B, Moir RD, et al. The common inhalation anesthetic isoflurane induces caspase activation and increases amyloid beta-protein level in vivo. Ann Neurol. 2008;64(6):618–27.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  62. Zhen Y, Dong Y, Wu X, Xu Z, Lu Y, Zhang Y, et al. Nitrous oxide plus isoflurane induces apoptosis and increases beta-amyloid protein levels. Anesthesiology. 2009;111(4):741–52.

    CAS  PubMed  Article  Google Scholar 

  63. Dong Y, Zhang G, Zhang B, Moir RD, Xia W, Marcantonio ER, et al. The common inhalational anesthetic sevoflurane induces apoptosis and increases beta-amyloid protein levels. Arch Neurol. 2009;66(5):620–31.

    PubMed  PubMed Central  Article  Google Scholar 

  64. Le Freche H, Brouillette J, Fernandez-Gomez FJ, Patin P, Caillierez R, Zommer N, et al. Tau phosphorylation and sevoflurane anesthesia: an association to postoperative cognitive impairment. Anesthesiology. 2012;116(4):779–87.

    PubMed  Article  CAS  Google Scholar 

  65. Sotiropoulos I, Catania C, Pinto LG, Silva R, Pollerberg GE, Takashima A, et al. Stress acts cumulatively to precipitate Alzheimer’s disease-like tau pathology and cognitive deficits. J Neurosci. 2011;31(21):7840–7.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  66. Green KN, Billings LM, Roozendaal B, McGaugh JL, LaFerla FM. Glucocorticoids increase amyloid-beta and tau pathology in a mouse model of Alzheimer’s disease. J Neurosci. 2006;26(35):9047–56.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  67. Arenaza-Urquijo EM, Przybelski SA, Machulda MM, Knopman DS, Lowe VJ, Mielke MM, et al. Better stress coping associated with lower tau in amyloid-positive cognitively unimpaired older adults. Neurology. 2020;94(15):e1571–9.

    PubMed  PubMed Central  Article  Google Scholar 

  68. Dorszewska J, Prendecki M, Oczkowska A, Dezor M, Kozubski W. Molecular basis of familial and sporadic Alzheimer’s disease. Curr Alzheimer Res. 2016;13(9):952–63.

    CAS  PubMed  Article  Google Scholar 

  69. Abelha FJ, Fernandes V, Botelho M, Santos P, Santos A, Machado JC, et al. Apolipoprotein E e4 allele does not increase the risk of early postoperative delirium after major surgery. Journal of anesthesia. 2012.

  70. Adamis D, Treloar A, Martin FC, Gregson N, Hamilton G, Macdonald AJ. APOE and cytokines as biological markers for recovery of prevalent delirium in elderly medical inpatients. Int J Geriatr Psychiatry. 2007;22(7):688–94.

    PubMed  Article  Google Scholar 

  71. Alexander SA, Ren D, Gunn SR, Kochanek PM, Tate J, Ikonomovic M, et al. Interleukin 6 and apolipoprotein E as predictors of acute brain dysfunction and survival in critical care patients. Am J Crit Care. 2014;23(1):49–57.

    PubMed  PubMed Central  Article  Google Scholar 

  72. Bryson GL, Wyand A, Wozny D, Rees L, Taljaard M, Nathan H. A prospective cohort study evaluating associations among delirium, postoperative cognitive dysfunction, and apolipoprotein E genotype following open aortic repair. Can J Anaesth. 2011;58(3):246–55.

    PubMed  Article  Google Scholar 

  73. Vasunilashorn SM, Ngo LH, Inouye SK, Fong TG, Jones RN, Dillon ST, et al. Apolipoprotein E genotype and the association between C-reactive protein and postoperative delirium: Importance of gene-protein interactions. Alzheimers Dement. 2020;16(3):572–80.

    PubMed  PubMed Central  Article  Google Scholar 

  74. Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344(6):395–402.

    CAS  PubMed  Article  Google Scholar 

  75. Steed L, Kong R, Stygall J, Acharya J, Bolla M, Harrison MJ, et al. The role of apolipoprotein E in cognitive decline after cardiac operation. Ann Thorac Surg. 2001;71(3):823–6.

    CAS  PubMed  Article  Google Scholar 

  76. Tardiff BE, Newman MF, Saunders AM, Strittmatter WJ, Blumenthal JA, White WD, et al. Preliminary report of a genetic basis for cognitive decline after cardiac operations. The Neurologic Outcome Research Group of the Duke Heart Center. Ann Thorac Surg. 1997;64(3):715–20.

  77. Wattmo C, Blennow K, Hansson O. Cerebro-spinal fluid biomarker levels: phosphorylated tau (T) and total tau (N) as markers for rate of progression in Alzheimer’s disease. BMC Neurol. 2020;20(1):10.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  78. Blennow K, Zetterberg H. Biomarkers for Alzheimer’s disease: current status and prospects for the future. J Intern Med. 2018;284(6):643–63.

    CAS  PubMed  Article  Google Scholar 

  79. Karikari TK, Emersic A, Vrillon A, Lantero-Rodriguez J, Ashton NJ, Kramberger MG, et al. Head-to-head comparison of clinical performance of CSF phospho-tau T181 and T217 biomarkers for Alzheimer’s disease diagnosis. Alzheimers Dement. 2021;17(5):755–67.

    CAS  PubMed  Article  Google Scholar 

  80. Teunissen CE, Verberk IMW, Thijssen EH, Vermunt L, Hansson O, Zetterberg H, et al. Blood-based biomarkers for Alzheimer's disease: towards clinical implementation. The Lancet Neurology. 2021.

  81. Berger M, Schenning KJ, Brown CHt, Deiner SG, Whittington RA, Eckenhoff RG, et al. Best practices for postoperative brain health: recommendations From the Fifth International Perioperative Neurotoxicity Working Group. Anesth Analg. 2018.

  82. Berger M, Burke J, Eckenhoff R, Mathew J. Alzheimer’s disease, anesthesia, and surgery: a clinically focused review. J Cardiothorac Vasc Anesth. 2014;28(6):1609–23.

    PubMed  Article  Google Scholar 

  83. Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Br J Anaesth. 2018;121(5):1005–12.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  84. Crosby G, Culley DJ, Hyman BT. Preoperative cognitive assessment of the elderly surgical patient: a call for action. Anesthesiology. 2011;114(6):1265–8.

    PubMed  Article  Google Scholar 

  85. Hogue CW, Selnes OA, McKhann G. Should all patients undergoing cardiac surgery have preoperative psychometric testing: a brain stress test? Anesth Analg. 2007;104(5):1012–4.

    PubMed  Article  Google Scholar 

  86. Lin JS, O'Connor E, Rossom RC, Perdue LA, Eckstrom E. Screening for cognitive impairment in older adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;159(9):601–12.

  87. Surgeons ACo. Optimal resources for geriatric surgery: 2019 standards. 633 N. Saint Clair St., Chicago, IL. 2019.

  88. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22.

    PubMed  Article  Google Scholar 

  89. Mahanna-Gabrielli E, Schenning KJ, Eriksson LI, Browndyke JN, Wright CB, Culley DJ, et al. State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018. Br J Anaesth. 2019;123(4):464–78.

    PubMed  PubMed Central  Article  Google Scholar 

  90. Shafer SL. Anesthesia & Analgesia’s 2015 Collection on the perioperative surgical home. Anesth Analg. 2015;120(5):966–7.

    PubMed  Article  Google Scholar 

  91. Shafer SL, Donovan JF. Anesthesia & Analgesia’s collection on the perioperative surgical home. Anesth Analg. 2014;118(5):893–5.

    PubMed  Article  Google Scholar 

  92. Alvis BD, Amsler RG, Leisy PJ, Feng X, Shotwell MS, Pandharipande PP, et al. Effects of an anesthesia perioperative surgical home for total knee and hip arthroplasty at a Veterans Affairs Hospital: a quality improvement before-and-after cohort study. Can J Anaesth. 2021;68(3):367–75.

    CAS  PubMed  Article  Google Scholar 

  93. Arias F, Wiggins M, Urman RD, Armstrong R, Pfeifer K, Bader AM, et al. Rapid in-person cognitive screening in the preoperative setting: test considerations and recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI). Perioper Care Oper Room Manag. 2020;19.

  94. Arias F, Wiggins M, Urman RD, Armstrong R, Pfeifer K, Bader AM, et al. Rapid in-person cognitive screening in the preoperative setting: test considerations and recommendations from the Society for Perioperative Assessment and Quality Improvement (SPAQI). J Clin Anesth. 2020;62:109724.

  95. Wiggins M, Arias F, Urman RD, Richman DC, Sweitzer BJ, Edwards AF, et al. Common neurodegenerative disorders in the perioperative setting: recommendations for screening from the Society for Perioperative Assessment and Quality Improvement (SPAQI). Perioper Care Oper Room Manag. 2020;20.

  96. Libon DJ, Malamut BL, Swenson MR, Cloud BS. Further analysis of clock drawings among demented and non-demented subjects. Arch Clin Neuropsychol. 1996;11:193–211.

    CAS  PubMed  Article  Google Scholar 

  97. Borson S, Scanlan JM, Chen P, Ganguli M. The Mini-Cog as a screen for dementia: validation in a population-based sample. J Am Geriatr Soc. 2003;51(10):1451–4.

    PubMed  Article  Google Scholar 

  98. Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.

  99. Lamar M, Price CC, Davis KL, Kaplan E, Libon DJ. Capacity to maintain mental set in dementia. Neuropsychologia. 2002;40(4):435–45.

    PubMed  Article  Google Scholar 

  100. Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short orientation-memory-concentration test of cognitive impairment. Am J Psychiatry. 1983;140(6):734–9.

    CAS  PubMed  Article  Google Scholar 

  101. O’Sullivan D, O’Regan NA, Timmons S. Validity and reliability of the 6-item cognitive impairment test for screening cognitive impairment: a review. Dement Geriatr Cogn Disord. 2016;42(1–2):42–9.

    PubMed  Article  Google Scholar 

  102. Welsh KA, Breitner JCS, Magruder-Habib KM. Detection of dementia in the elderly using telephone screening of cognitive status. Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology. 1993;6(2):103.

    Google Scholar 

  103. Inouye SK, Robison JT, Froehlich TE, Richardson ED. The time and change test: a simple screening test for dementia. J Gerontol A Biol Sci Med Sci. 1998;53(4):M281–6.

    CAS  PubMed  Article  Google Scholar 

  104. Libon DJ, Swenson RA, Barnoski EJ, Sands LP. Clock drawing as an assessment tool for dementia. Arch Clin Neuropsychol. 1993;8(5):405–15.

    CAS  PubMed  Article  Google Scholar 

  105. Frei BW, Woodward KT, Zhang MY, Amini S, Tighe P, Garvan CW, Giordano C, Price CC. Considerations for Clock Drawing Scoring Systems in Perioperative Anesthesia Settings. Anesth Analg. 2019 May;128(5):e61–e64. https://doi.org/10.1213/ANE.0000000000004105. PMID: 30896604; PMCID: PMC6545889.

  106. Price CC, Cunningham H, Coronado N, Freedland A, Cosentino S, Penney DL, et al. Clock drawing in the Montreal Cognitive Assessment: recommendations for dementia assessment. Dement Geriatr Cogn Disord. 2011;31(3):179–87.

    PubMed  PubMed Central  Article  Google Scholar 

  107. Buckley RA, Atkins KJ, Fortunato E, Silbert B, Scott DA, Evered L. A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: a feasibility study. Acta Anaesthesiol Scand. 2020.

  108. Hizel LP, Warner ED, Wiggins ME, Tanner JJ, Parvataneni H, Davis R, et al. Clock drawing performance slows for older adults after total knee replacement surgery. Anesth Analg. 2019;129(1):212–9.

    PubMed  PubMed Central  Article  Google Scholar 

  109. Davoudi A, Dion C, Formanski E, Frank BE, Amini S, Matusz EF, et al. Normative references for graphomotor and latency digital clock drawing metrics for adults age 55 and older: operationalizing the production of a normal appearing clock. J Alzheimers Dis. 2021;82(1):59–70.

    PubMed  PubMed Central  Article  Google Scholar 

  110. Davoudi A, Dion C, Amini S, Libon DJ, Tighe PJ, Price CC, et al. Phenotyping cognitive impairment using graphomotor and latency features in digital clock drawing test. Annu Int Conf IEEE Eng Med Biol Soc. 2020;2020:5657–60.

    PubMed  PubMed Central  Google Scholar 

  111. Davoudi A, Dion C, Amini S, Tighe PJ, Price CC, Libon DJ, et al. Classifying non-dementia and Alzheimer’s disease/vascular dementia patients using kinematic, time-based, and visuospatial parameters: the digital clock drawing test. J Alzheimers Dis. 2021;82(1):47–57.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  112. Dion C, Frank BE, Crowley SJ, Hizel LP, Rodriguez K, Tanner JJ, et al. Parkinson’s disease cognitive phenotypes show unique clock drawing features when measured with digital technology. J Parkinsons Dis. 2021;11(2):779–91.

    PubMed  PubMed Central  Article  Google Scholar 

  113. Libon DJ, Malamut BL, Swenson R, Sands LP, Cloud BS. Further analyses of clock drawings among demented and nondemented older subjects. Arch Clin Neuropsychol. 1996;11(3):193–205.

    CAS  PubMed  Article  Google Scholar 

  114. McDonald SR, Heflin MT, Whitson HE, Dalton TO, Lidsky ME, Liu P, et al. Association of integrated care coordination with postsurgical outcomes in high-risk older adults: the Perioperative Optimization of Senior Health (POSH) Initiative. JAMA Surg. 2018;153(5):454–62.

    PubMed  PubMed Central  Article  Google Scholar 

  115. Hamlet KM, Pasternak E, Rabai F, Mufti M, Hernaiz Alonso C, Price CC. Perioperative multidisciplinary delirium prevention: a longitudinal case report. A A Pract. 2021;15(1):e01364.

  116. Arias F, Bursian AC, Sappenfield JW, Price CE. Delirium history and preoperative mild neurocognitive disorder: An Opportunity for Multidisciplinary Patient-Centered Care. Am J Case Rep. 2018 Nov 6;19:1324-1328. https://doi.org/10.12659/AJCR.911437. PMID: 30397190; PMCID: PMC6232917.

  117. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–57.

    CAS  PubMed  Article  Google Scholar 

  118. Frei BW, Woodward KT, Zhang MY, Amini S, Tighe P, Garvan CW, et al. Considerations for clock drawing scoring systems in perioperative anesthesia settings. Anesth Analg. 2019;128(5):e61–4.

    PubMed  PubMed Central  Article  Google Scholar 

  119. Amini S, Crowley S, Hizel L, Arias F, Libon DJ, Tighe P, et al. Feasibility and rationale for incorporating frailty and cognitive screening protocols in a preoperative anesthesia clinic. Anesth Analg. 2019.

  120. Arias F, Riverso M, Levy SA, Armstrong R, Estores DS, Tighe P, et al. Pilot study: neurocognitive disorders and colonoscopy in older adults. Anesth Analg. 2019.

  121. Price CC, Levy SA, Tanner J, Garvan C, Ward J, Akbar F, et al. Orthopedic surgery and post-operative cognitive decline in idiopathic Parkinson’s disease: considerations from a pilot study. J Parkinsons Dis. 2015;5(4):893–905.

    PubMed  PubMed Central  Article  Google Scholar 

  122. Program NRM. National resident matching program, results and data: specialties matching service 2021 appointment year. Washington, DC; 2021.

  123. Hughes CG, Boncyk CS, Culley DJ, Fleisher LA, Leung JM, McDonagh DL, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention. Anesth Analg. 2020;130(6):1572–90.

    PubMed  PubMed Central  Article  Google Scholar 

  124. Solberg LM, Campbell CS, Jones K, Vaughn I, Suryadevara U, Fernandez C, et al. Training hospital inpatient nursing to know (THINK) delirium: A nursing educational program. Geriatr Nurs. 2021;42(1):16–20.

    PubMed  Article  Google Scholar 

  125. Hayhurst CJ, Pandharipande PP, Hughes CG. Intensive care unit delirium: a review of diagnosis, prevention, and treatment. Anesthesiology. 2016;125(6):1229–41.

    PubMed  Article  Google Scholar 

  126. Jones TS, Jones EL, Barnett CC Jr, Moore JT, Wikiel KJ, Horney CP, et al. A multidisciplinary high-risk surgery committee may improve perioperative decision making for patients and physicians. J Palliat Med. 2021;24(12):1863–6.

    PubMed  Article  Google Scholar 

  127. Lloyd-Sherlock P, Kalache A, Kirkwood T, McKee M, Prince M. WHO’s proposal for a decade of healthy ageing. Lancet. 2019;394(10215):2152–3.

    PubMed  Article  Google Scholar 

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Acknowledgements

I sincerely thank the reviewers for their comments and Shawna Amini, MPH, and Christina Hendricks, B.S, for the Figure 3 infographic. Thank you to Laura Anderson for her time editing this manuscript.

Funding

Support was provided through K07 AG066813 and a Paul Satz Term Professorship. Perioperative and neurodegenerative research and career research training were provided through R01 NS082386, K23 NS060660, NIA R01 AG055337, NSF 13–543, and R01 NR014810.

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  1. Clinical and Health Psychology, Anesthesiology, University of Florida, Gainesville, FL, USA

    Catherine C. Price

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Price, C.C. The New Frontier of Perioperative Cognitive Medicine for Alzheimer’s Disease and Related Dementias. Neurotherapeutics 19, 132–142 (2022). https://doi.org/10.1007/s13311-021-01180-w

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Keywords

  • Anesthesia
  • Cognitive disorders
  • Evidence-based medicine
  • Delivery of health
  • Delirium
  • Neuropsychology