Feasibility of administrating a cognitive screening tool by telephone prior to surgery in older adults-preliminary results
Bibliographic record
Abstract
Background: Preoperative cognitive assessment has been advocated for adults ≥ 65 years-old due to increased risk for post-operative complications such as postoperative delirium, postoperative cognitive decline, and increased mortality. Most screening tools for cognitive impairment require in-person evaluation. During the COVID-19 pandemic, most medical centers have changed their workflows to telemedicine platforms. In this study we aim to assess the feasibility of a telephone-based cognitive assessment tool, the Mini-Montreal Cognitive Assessment (Mini-MOCA) prior to surgery and 30-day post surgery to evaluate any changes in cognitive function. Methods: Patients age ≥70 year who were candidates for surgery and had a telemedicine visit in the preoperative clinic during December 2020 were included. Exclusion criteria included hearing impairment, day-surgery, inability to speak English and a prior diagnosis of Dementia. Eligible patients were asked to complete an attention test, the Mini-MOCA and function assessment using the Katz score for activities of daily living (ADL) and Lawton-Brody for instrumental activities of daily living (IADL). Anxiety was assessed using the Generalized Anxiety Disorder 2-item (GAD-2). Baseline demographics including medications and education level were collected. Anti-cholinergic effect was assessed using an anti-cholinergic score calculator (ACS). Results: Overall 24 patients completed the preoperative assessment. The cohort was 50% female, white (96%), with a median age of 74 years (range: 71-82). The median number of medications was 8 (range:2-20), 16/24 (67%) taking medications with anti-cholinergic effects and a median ACS of 1 (range 1-13), and 4/24 (17%) on Benzodiazepines. The median Katz score was 6 (range: 4-6) and Lawton-Brody score 8 (range: 5-8). The mean time for completion of the phone assessment was 10 minutes and 4 minutes for the Mini- MOCA. The median Mini-MOCA score was 13.5 (range: 9-15). Conclusions: In our preliminary results we show that a telephone- based cognitive assessment prior to surgery is well accepted and feasible among older adults who are candidates for surgery. Our study is ongoing, and will continue to conduct pre- and post-operative cognitive evaluations (updated results will be presented).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".