Pain catastrophizing and frailty in adult spinal deformity patients with cognitive impairment
Bibliographic record
Abstract
OBJECTIVE: Cognitive impairment and pain catastrophizing are both associated with worse surgical outcomes. The aim of this study was to define the prevalence of cognitive impairment in patients with adult spinal deformity (ASD) and the relationships between cognitive impairment, pain catastrophizing, patient-reported outcome measures (PROMs), and frailty in the preoperative setting. METHODS: This cross-sectional study included patients undergoing evaluation for ASD correction at a single tertiary care center from January 2017 to October 2024. Patients were administered the Montreal Cognitive Assessment (MoCA), Pain Catastrophizing Scale (PCS), Scoliosis Research Society 22-item revised (SRS-22r) questionnaire, the Oswestry Disability Index (ODI), and the Edmonton Frail Scale (EFS). Median survey responses were compared between patients with any cognitive impairment (MoCA score < 26) and no cognitive impairment (MoCA score ≥ 26) using the Mann-Whitney U-test. Associations between survey responses were tested using Spearman's rank correlation analysis. Multivariate logistic regression analysis was performed to identify predictors of severe pain catastrophizing (PCS score ≥ 30). RESULTS: A total of 210 patients (61.4% female, median age 66.5 years) were included in the study. Of these, 123 (58.6%) had normal cognition and 87 (41.4%) had mild or moderate cognitive impairment. Patients with cognitive impairment had greater median PCS scores compared with patients with normal cognition (total PCS score 25.0 vs 19.0, p = 0.01). Lower MoCA scores were significantly correlated with higher PCS (ρ = -0.23, p = 0.0007) and EFS (ρ = -0.21, p = 0.0074) scores, but not ODI and total SRS-22r scores. In the multivariate logistic regression analysis, lower MoCA and SRS-22r scores were associated with greater odds of having severe pain catastrophizing (MoCA: OR 0.82 [95% CI 0.68-0.98], p = 0.03; SRS-22r: OR 0.05 [95% CI 0.01-0.19], p < 0.0001), while ODI score, EFS score, age, and sex were not associated. CONCLUSIONS: There was a high prevalence (41.4%) of cognitive impairment in patients with ASD. In both the correlation and multivariate logistic regression analyses, cognitive impairment was associated with pain catastrophizing and thus might contribute to pain perception and frailty in a way that is not consistently captured by traditional PROMs.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".