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Choice reaction time in patients with post-operative cognitive dysfunction.

J Steinmetz¹, L S Rasmussen,

¹Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. jacob.steinmetz@rh.regionh.dk

Acta Anaesthesiologica Scandinavica

|November 3, 2007

Summary

Choice reaction time (CRT) testing shows an association with post-operative cognitive dysfunction (POCD). However, CRT is a poor predictor for identifying POCD in older surgical patients.

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Area of Science:

Geriatric Medicine
Neuroscience
Anesthesiology

Background:

Post-operative cognitive dysfunction (POCD) is typically assessed using neuropsychological tests.
Reaction time testing, specifically choice reaction time (CRT), has not been a standard component of POCD assessment.
This study investigates the potential of CRT as a screening tool for POCD.

Purpose of the Study:

To determine if choice reaction time (CRT) can serve as a screening tool for post-operative cognitive dysfunction (POCD).
To analyze the association between CRT performance and the presence of POCD in elderly patients undergoing major surgery.

Main Methods:

Elderly patients (≥60 years) undergoing major surgery with general anesthesia were recruited internationally.
Choice reaction time (CRT) was measured 52 times using the four boxes test pre-operatively, at 1 week, and 3 months post-operatively.
Receiver-operator characteristic (ROC) curves were used to evaluate CRT's effectiveness as a POCD screening tool.

Main Results:

Patients with POCD exhibited significantly longer reaction times at both 1 week (857 ms vs. 762 ms) and 3 months post-surgery compared to those without POCD.
Optimal CRT cut-off times for predicting POCD were identified as 813 ms at 1 week and 762 ms at 3 months.
The positive predictive value of CRT for POCD was low, at 34.4% (1 week) and 14.7% (3 months).

Conclusions:

Post-operative cognitive dysfunction (POCD) is associated with slower choice reaction time (CRT) performance.
Despite the association, CRT is not a reliable predictor for identifying POCD in this patient population.
Further research may be needed to explore other screening methods or refine CRT application.