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Domain-Specific Subjective Cognitive complaints and Cognitive Test Performance After Surgery in Older Adults: A
Brian J Lilienstein1, Laura P Sands2, Serena Padda3
1Rosalind Franklin University of Medicine and Science (BJL), Chicago, IL; Department of Anesthesia and Perioperative Care (BJL, SP, JML), University of California, San Francisco, CA.
Background:
Subjective cognitive complaints are clinically important in the assessment of perioperative neurocognitive changes because current nomenclature incorporates cognitive concerns reported by patients or others. However, the relationship between patients' subjective cognitive complaints and contemporaneous changes in cognitive test performance during the immediate postoperative period remains poorly understood.
Objectives:
To identify if subjective cognitive complaints reported before hospital discharge were associated with cognitive changes measured with cognitive tests.
Design:
Prospective cohort study.
Participants:
Patients aged ≥65 years undergoing elective noncardiac surgery.
Measurements:
Pre- and postoperatively for the first three days daily, patients' cognitive function was measured by the timed Verbal Fluency test, the Word List learning task, and Digit Span Backward to assess the cognitive domains of memory and learning (Word List), executive function (Verbal Fluency), attention and working memory (Digit Span Backward and Word List), and language (verbal fluency). Patient's subjective opinion of cognition was measured by the Subjective Cognitive Questionnaire (SCQ). The SCQ statements were matched to Word List; Verbal Fluency; and Digit Span Backwards respectively. Logistic regression analyses were performed for each pairing. Sensitivity, specificity, and receiver operating characteristic (ROC) curves were derived. Postoperative delirium was measured daily using the Confusion Assessment Method for the first 3 postoperative days.
Results:
About 197 patents were recruited and 10 excluded because of incomplete SCQ responses or missing delirium assessments. Subjective cognitive complaints were associated with objective decline on the following cognitive tests: Word List (OR 1.31, 95% CI 1.07-1.60; p = 0.008), Verbal Fluency (OR 1.79, 95% CI 1.37-2.34; p <0.0001), and Digit Span Backwards (OR 5.15, 95% CI 1.86-13.54, p = 0.001). Discrimination was poor to moderate (AUC 0.52-0.66), with generally higher specificity but low sensitivity.
Conclusions:
Subjective cognitive complaints were associated with objective perioperative cognitive decline. Patient-reported symptoms may reflect early cognitive vulnerability, however, subjective cognitive complaints showed low sensitivity, limiting their utility as standalone screening tools.
