Prediction of Postoperative Delirium After Cardiac Surgery with A Quick Test of Cognitive Speed, Mini-Mental State Examination and Hospital Anxiety and Depression Scale

Apr 11, 2022Clinical interventions in aging

Using Quick Thinking, Memory, and Mood Tests to Predict Delirium After Heart Surgery

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Abstract

Postoperative delirium occurred in 22% of 218 cardiac surgery patients.

Patients with postoperative delirium had lower Mini-Mental State Examination (MMSE) scores and slower A Quick Test of Cognitive Speed () times.
The area under the curve (AUC) for predicting delirium was 0.605 for AQT and 0.623 for MMSE.
Lower MMSE scores (<27 points), longer AQT times (>70 seconds), higher depressive symptoms (-D >4 points), and longer cardiopulmonary bypass time were associated with postoperative delirium.
Combining cognitive tests and depressive symptom screening improved predictive power to an AUC of 0.736.

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PURPOSE: To evaluate if preoperative assessment with A Quick Test of Cognitive Speed () could increase the accuracy of predicting delirium after cardiac surgery compared to Mini-Mental State Examination (MMSE), and examine if a composite of variables, including cognitive function and depressive symptoms, could be useful to predict delirium.

PATIENTS AND METHODS: Cardiac surgery was performed in 218 patients (mean age 72 years). Preoperative evaluation involved AQT, MMSE and Hospital Anxiety And Depression Scale (). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) and Confusion Assessment Method-ICU (CAM-ICU). Logistic regression was performed to detect predictors of postoperative delirium and receiver operator characteristic curves (ROC) with area under the curve (AUC) to determine the accuracy.

RESULTS: Postoperative delirium occurred in 47 patients (22%) who had lower MMSE scores (median (range), 27 (19-30) vs 28 (20-30),=0.009) and slower AQT (median (range), 76 (48-181) vs 70 (40-182) seconds,=0.030) than patients without delirium. Predictive power measured as AUC (95% CI) was 0.605 (0.51-0.70) for AQT and 0.623 (0.53-0.72) for MMSE. Logistic regression (OR, 95% CI) showed MMSE <27 points (2.72, 1.27-5.86), AQT >70 sec (2.26, 1.03-4.95), HADS-D >4 points (2.60, 1.21-5.58) and longer cardiopulmonary bypass-time (1.007, 1.002-1.013) to be associated with postoperative delirium. Combining these parameters yielded an AUC of 0.736 (0.65-0.82). p p

CONCLUSION: The ability of predicting delirium using AQT was similar to MMSE, and only slightly higher by combining AQT and MMSE. Adding HADS-D and cardiopulmonary bypass-time to MMSE and AQT increased the predictive power to a borderline acceptable discriminatory value. Preoperative cognitive tests and screening for depressive symptoms may help identify patients at risk of postoperative delirium. Yet, there is still a need to establish useful preoperative tests.

Key numbers

47 of 218

Postoperative Delirium Rate

Number of patients developing delirium among total patients undergoing surgery.

0.736

AUC for Composite Model

Area under the curve for the model combining MMSE, , -D, and bypass time.

Median MMSE Score

Median MMSE score for patients with delirium.

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Prediction of Postoperative Delirium After Cardiac Surgery with A Quick Test of Cognitive Speed, Mini-Mental State Examination and Hospital Anxiety and Depression Scale

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