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Pre-Fracture Cognitive Assessment Using the DASC-21 and Postoperative Delirium Risk
Tomoko Kamimura1, Satoshi Tamaki2, Yuya Kobayashi3
1Department of Health Sciences, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Summary
Postoperative delirium (POD) is common in elderly hip fracture patients. Pre-fracture cognitive impairment, assessed by DASC-21, significantly increases POD risk, showing similar predictive power to MMSE.
Area of Science:
- Geriatric Medicine
- Neuroscience
- Surgical Complications
Background:
- Postoperative delirium (POD) is a frequent complication in elderly patients undergoing hip fracture surgery.
- Accurate assessment of baseline cognitive function is crucial but challenging in acute settings.
- Informant-based cognitive assessments may offer insights into premorbid cognitive status.
Purpose of the Study:
- To evaluate the utility of the Dementia Assessment Sheet for Community-based Integrated Care System (DASC-21) in assessing pre-fracture cognitive impairment.
- To determine the association between pre-fracture cognitive status and the incidence of POD in hip fracture patients.
- To compare the discriminative performance of DASC-21 with the Mini-Mental State Examination (MMSE) for predicting POD.
Main Methods:
- Retrospective analysis of a prospective cohort of patients aged ≥80 years undergoing hip fracture surgery.
- Pre-fracture cognition assessed using DASC-21 (informant-based) and MMSE.
- POD assessed using the Confusion Assessment Method within three days post-surgery.
- Multivariable logistic regression analyses were employed.
Main Results:
- POD developed in 37.2% of 368 patients.
- POD incidence was significantly higher with increasing pre-fracture cognitive impairment (mild: 44.3%, moderate-to-severe: 48.7%).
- Mild pre-fracture cognitive impairment (DASC-21) was associated with a 14-fold increased odds of POD (adjusted OR 14.11).
- DASC-21 and MMSE showed comparable discriminative performance for POD (AUC 0.74 vs. 0.75).
Conclusions:
- Pre-fracture cognitive impairment, even mild, is a significant risk factor for POD in elderly hip fracture patients.
- The DASC-21 is a valuable tool for estimating baseline cognitive vulnerability in acute settings.
- DASC-21 demonstrates comparable predictive ability to MMSE for POD in this population.
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