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Neurocognitive Screening for POCD via the iPad. Sarah Waring and Emily Whitaker Advised by: Dr. James L. Blair, VUMC Anesthesiology Dept. Overview of POCD. Cognitive Dysfunction  impairment of vital mental processes

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neurocognitive screening for pocd via the ipad

Neurocognitive Screening for POCD via the iPad

Sarah Waring and Emily Whitaker

Advised by: Dr. James L. Blair, VUMC Anesthesiology Dept.

overview of pocd
Overview of POCD
  • Cognitive Dysfunction  impairment of vital mental processes
  • After surgery with anesthesia  post operative cognitive dysfunction (POCD)
    • Etiology unknown
  • More common in elderly patients
    • Affects perception, memory, and information processing
    • Problems can persist for several months
    • Impedes activities of daily living (ADL)
overview of neurocognitive tests

First two lines are easy to read  ink = word

Now it gets tricky  ink ≠ word

Overview of Neurocognitive Tests
  • Stroop test
    • Developed at Vanderbilt!
    • Assesses concept shifting ability and executive function
    • Example:

http://www.cs.dartmouth.edu/farid/illusions/stroop.html

the problem
The Problem
  • “Comprehensive” pre-operative screening neglects brain
    • All other major organs are tested
    • If communicating
  • Elderly patients often end up with some degree of POCD
  • Causes need for assistance with ADL
  • Causes increased mortality risk for next year
current solutions
Current “Solutions”
  • Neurocognitive testing (NCT) after surgery to assess mental functions
    • One week and three months post-surgery
  • These tests determine presence of POCD
    • Accuracy without a pre-op baseline?
group purpose
Group Purpose
  • A pre-operative test of mental function is needed
    • MRI/DTI/fMRI
    • Neurocognitive testing (NCT)
  • Values can be obtained for baseline
    • Physiological
    • Neurocognitive abilities
  • Can NCT be a screening tool for high risk of POCD?
    • Upcoming study will compare NCT results to physiological changes
group objective
Group Objective
  • Create an iPad program that will be used to administer a battery of neurocognitive tests as part of the pre-op screening process
    • Must be: user friendly, in touch screen format, easy to administer, and take approx. 10 min.
    • Develop scoring methods for program
    • Stroop test to start; other tests added later
completed work
Completed Work
  • Met with Dr. Blair to discuss overall project objectives
    • Received project protocol
  • Decided to focus initially on Stroop test
    • Research into Stroop test, both paper- and computer-based versions
  • Research into POCD
  • Research into iPad programming
current work
Current Work
  • Initial program coding
  • Research into relevant neurocognitive tests
    • Searching for computerized versions of Stroop test, “finger tapping,” JLO, and HVLT
  • Research into licensing of tests
future work
Future Work
  • Continue to meet with Dr. Blair to discuss our role in project
  • Determine appropriate scoring method for Stroop test
  • Finish program coding
  • Obtain iPad and begin testing
  • Administer to patients and test program performance
references
References
  • Hanning CD. Postoperative cognitive dysfunction. Br J of Anaesth. Jan 2005;95(1):82-87
  • Monk TG, Weldon BC, Garvan CW, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. Jan 2008;108(1):18-30
  • Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. Jan 2005;100(1):4-10
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