Neurocognitive screening for pocd via the ipad
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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