Perioperative cognitive changes in older adults undergoing major non‐cardiac surgery
Bibliographic record
Abstract
BACKGROUND: Approximately one-third of adults over the age of 65 undergoing surgery experience severe cognitive impairments, including acute confusion, attention deficits, and global cognitive dysfunction. Older adults with greater cognitive impairments are at increased risk for prolonged hospitalization, higher rates of readmission, institutionalization, and long-term cognitive decline, including dementia and Alzheimer's disease. However, the trajectory of postoperative cognitive changes in older adults remains poorly understood. Cognitive assessments such as the Montreal Cognitive Assessment (MOCA) are commonly used in clinical settings but are often interpreted as a single total score, overlooking domain-specific cognitive changes. To address this research gap, this study examines domain-specific cognitive changes in older surgical patients before and after surgery. METHOD: Seventeen older surgical patients (≥70 years old) undergoing knee, hip, or spine surgery were recruited. Cognitive function was assessed pre- and post-surgery using the Montreal Cognitive Assessment (MOCA). Assessments were captured 1-week before surgery and 1-day post-surgery. A linear mixed-effects model was used to evaluate cognitive function pre- and post-surgery across the following cognitive domains, abstraction, attention, language, orientation, and recall. RESULT: The analysis revealed an interaction effect between event group (pre- vs. post-surgery) and the MOCA cognitive domains (F(4,126) = 6.97, p < 0.01), indicating that post-operative cognitive functions possibly decline at different rates across cognitive domains. Attention, orientation, and recall demonstrated the strongest effects, where the recall domain showed significant decline following surgery compared to baseline (β = -0.87 (standardized), SE = 0.156, p < 0.01), suggesting a domain-specific vulnerability in memory function. CONCLUSION: Our findings indicate that postoperative cognitive decline is domain-specific, with memory function exhibiting the greatest vulnerability and possibly a slower recovery trajectory. These results suggest that assessing cognitive domains individually, rather than relying solely on total MOCA scores, may advance early detection of patients at risk for prolonged cognitive impairment. Follow-up studies are warranted to determine whether domain-specific cognitive assessments can serve as predictors of long-term cognitive decline, including postoperative delirium and dementia, ultimately guiding early interventions to improve patient outcomes. This research was supported by AACSF-23-1148490.
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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 | 0.000 | 0.002 |
| 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) | 0.001 | 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 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".