Optimizing Postoperative Cognition the Elderly

Study Overview
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Brief Summary
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This study will recruit surgical patients more than 65 years old. Patients who participate will wear a sticker on their forehead during surgery which monitors their brain waves (electroencephalogram, EEG) and participate in memory testing before and after surgery. Brain wave patterns will be compared between patients who have problems with memory and thinking after surgery and those who do not. The hypothesis is that there will be characteristic brain wave patients for who will go on to have problems with memory and thinking after surgery.

Detailed Description
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Eligible patients will be identified through the computerized scheduling system at the Icahn School of Medicine at Mount Sinai. After informed consent, patients will complete cognitive and tests at least one but not more than 30 days prior to surgery. In the recovery room the Post Anesthesia Recovery Scale (PQRS), and CAM-ICU delirium screening will be administered. Immediate recovery will be recorded using the Postoperative Recovery Scale (PQRS) on postoperative day 1 and 3, and 1 week. Longterm functional recovery will be measured with the Alzheimer's Disease Research Center (ADRC) Instrumental Activities for Daily Living (IADL-24). Postsurgical complications will be recorded including unplanned ICU admissions, postoperative myocardial infarction and stroke (risk less than 1 % in most cases), wound infection and reoperation. The full cognitive and functional battery will be repeated at 3 months and 1 year after surgery.

Official Title
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Optimizing Postoperative Cognition the Elderly

Conditions
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Postoperative Cognitive Dysfunction, POCD

Intervention / Treatment
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* Procedure: Processed EEG


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 65 years of age and older having major elective non-cardiac surgery requiring general anesthesia requiring at least a 2 day hospital stay Exclusion Criteria: previous diagnosis of dementia, stroke, cardiac or intracranial surgery inability to consent or communicate in English or Spanish major uncorrected hearing or vision deficit, Parkinson's disease, or major psychiatric disease which will be determined by phone interview and computer medical records abstracted by the primary investigator.

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Elective Non Cardiac Surgical Patients<br>65 years of age and older | Procedure: Processed EEG<br>* In the operating room. Processed EEG will be measured using the Bispectral Index (BIS) monitor which is standard of care.<br>* Other names: brain waves;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| UDS battery | Postoperative Cognitive Dysfunction - UDS battery is the standard ADRC neuropsychological battery and will be used to measure cognition | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Processed EEG | Processed EEG will be measured using the Bispectral Index (BIS) monitor. | 1 year | 
| CAM-ICU | The Confusion Assessment Method-ICU is a delirium screening tool for Intensive Care Unit (ICU) patients, assessing 4 features: alteration/fluctuation in mental status, Inattention, altered level of consciousness, and disorganized thinking. | baseline | 
| CAM-ICU | The Confusion Assessment Method-ICU is a delirium screening tool for Intensive Care Unit (ICU) patients, assessing 4 features: alteration/fluctuation in mental status, Inattention, altered level of consciousness, and disorganized thinking. | Day 1 | 
| CAM-ICU | The Confusion Assessment Method-ICU is a delirium screening tool for Intensive Care Unit (ICU) patients, assessing 4 features: alteration/fluctuation in mental status, Inattention, altered level of consciousness, and disorganized thinking. | Day 3 | 
| CAM-ICU | The Confusion Assessment Method-ICU is a delirium screening tool for Intensive Care Unit (ICU) patients, assessing 4 features: alteration/fluctuation in mental status, Inattention, altered level of consciousness, and disorganized thinking. | 1 week | 
| PQRS | Short -Term Recovery: Postoperative Quality of Recovery Scale (PQRS) | baseline | 
| PQRS | Short -Term Recovery: Postoperative Quality of Recovery Scale (PQRS) | Day 1 | 
| PQRS | Short -Term Recovery: Postoperative Quality of Recovery Scale (PQRS) | Day 3 | 
| PQRS | Short -Term Recovery: Postoperative Quality of Recovery Scale (PQRS) | 1 week | 
| UDS battery | Postoperative Cognitive Dysfunction - UDS battery is the standard ADRC neuropsychological battery and will be used to measure cognition | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Postoperative Cognitive Dysfunction, Elderly, geriatric, Anesthesia, Anesthetic depth, Bispectral index monitor, Function, Recovery after surgery, Surgery