Purpose The Montreal Cognitive Assessment (MoCA) is a validated screening tool for cognitive impairment (CI) in surgical populations that assesses multiple cognitive domains. The primary objective of this report was to characterize preoperative domain-specific performance on the MoCA in older surgical patients. The secondary objectives were to explore preoperative characteristics and adverse outcomes associated with poorer domain-specific performance. Methods This was a post hoc analysis of the Detection of Cognitive Impairment (Detect CI) study. The MoCA was administered preoperatively to assess seven cognitive domains: executive/visuospatial function, naming, attention, language, abstraction, delayed recall, and orientation. It was scored out of 30, with higher education-adjusted MoCA scores indicating better cognitive performance and scores <InlineEquation ID="IEq1"> <EquationSource Format="TEX">$\le$</EquationSource> <EquationSource Format="MATHML"><math> <mo>≤</mo> </math></EquationSource> </InlineEquation> 25 classifying probable CI. Adverse outcomes were collected in 382 participants at 30 days and 379 participants at 90 days postoperatively. Results The 382 participants (median age, 73 years [IQR, 68, 77]; 58% female) had a mean MoCA score of 25.9 <InlineEquation ID="IEq2"> <EquationSource Format="TEX">$\pm$</EquationSource> <EquationSource Format="MATHML"><math> <mo>±</mo> </math></EquationSource> </InlineEquation> 2.8, with 35% screening positive for CI. Participants with probable CI performed significantly poorer across all seven cognitive domains (executive/visuospatial function, naming, attention, language, abstraction, delayed recall, and orientation) than those without CI. Having <InlineEquation ID="IEq3"> <EquationSource Format="TEX">$\le$</EquationSource> <EquationSource Format="MATHML"><math> <mo>≤</mo> </math></EquationSource> </InlineEquation> 12 years of education was associated with poorer executive/visuospatial function, naming, language, abstraction, and delayed recall. Of all cognitive domains, exploratory analyses showed that only orientation was associated with 30-day adverse outcomes after adjusting for age, sex, education level, and/or American Society of Anesthesiologists status and within-domain multiplicity. Each one-point decrease in orientation score was associated with a longer length of stay (β = 0.5, 95% confidence interval [95% CI] 0.2–0.8; P <InlineEquation ID="IEq4"> <EquationSource Format="TEX">$=$</EquationSource> <EquationSource Format="MATHML"><math> <mo>=</mo> </math></EquationSource> </InlineEquation> 0.012) and higher adjusted odds of postoperative delirium (adjusted odds ratio [aOR] = 11.4, 95% CI 2.6–46.8; P <InlineEquation ID="IEq5"> <EquationSource Format="TEX">$=$</EquationSource> <EquationSource Format="MATHML"><math> <mo>=</mo> </math></EquationSource> </InlineEquation> 0.004), complications (aOR = 3.1, 95% CI 1.3–8.9; P <InlineEquation ID="IEq6"> <EquationSource Format="TEX">$=$</EquationSource> <EquationSource Format="MATHML"><math> <mo>=</mo> </math></EquationSource> </InlineEquation> 0.035), non-home discharge (aOR = 4.1, 95% CI 1.5–11.4; P <InlineEquation ID="IEq7"> <EquationSource Format="TEX">$=$</EquationSource> <EquationSource Format="MATHML"><math> <mo>=</mo> </math></EquationSource> </InlineEquation> 0.014), and composite adverse outcomes (aOR = 5.6, 95% CI 1.9–23.9; P <InlineEquation ID="IEq8"> <EquationSource Format="TEX">$=$</EquationSource> <EquationSource Format="MATHML"><math> <mo>=</mo> </math></EquationSource> </InlineEquation> 0.014). Orientation remained associated with postoperative delirium after adjusting for multiplicity both within and across MoCA domains (aOR = 11.4, 95% CI 2.6–46.8; P <InlineEquation ID="IEq9"> <EquationSource Format="TEX">$=$</EquationSource> <EquationSource Format="MATHML"><math> <mo>=</mo> </math></EquationSource> </InlineEquation> 0.031). Conclusions This analysis characterized preoperative domain-specific performance on the MoCA in older adults, with participants screening positive for CI exhibiting poorer performance across all cognitive domains. Exploratory findings suggested that orientation difficulties may be associated with early adverse outcomes, with postoperative delirium showing the most robust association.

Characterizing preoperative domain-specific performance on the Montreal Cognitive Assessment and exploring its associations with adverse outcomes

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2026年6月17日

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Ellene Yan,
Yasmin Alhamdah,
Aparna Saripella,
Eric Cheuk,
Sazzadul Islam,
David He,
Keera N. Fishman,
Leif Erik Lovblom,
Maria Carmela Tartaglia,
David F. Tang-Wai,
Jean Wong,
Frances Chung

摘要

Purpose

The Montreal Cognitive Assessment (MoCA) is a validated screening tool for cognitive impairment (CI) in surgical populations that assesses multiple cognitive domains. The primary objective of this report was to characterize preoperative domain-specific performance on the MoCA in older surgical patients. The secondary objectives were to explore preoperative characteristics and adverse outcomes associated with poorer domain-specific performance.

Methods

This was a post hoc analysis of the Detection of Cognitive Impairment (Detect CI) study. The MoCA was administered preoperatively to assess seven cognitive domains: executive/visuospatial function, naming, attention, language, abstraction, delayed recall, and orientation. It was scored out of 30, with higher education-adjusted MoCA scores indicating better cognitive performance and scores $\le$ $\leq$ 25 classifying probable CI. Adverse outcomes were collected in 382 participants at 30 days and 379 participants at 90 days postoperatively.

Results

The 382 participants (median age, 73 years [IQR, 68, 77]; 58% female) had a mean MoCA score of 25.9 $\pm$ $\pm$ 2.8, with 35% screening positive for CI. Participants with probable CI performed significantly poorer across all seven cognitive domains (executive/visuospatial function, naming, attention, language, abstraction, delayed recall, and orientation) than those without CI. Having $\le$ $\leq$ 12 years of education was associated with poorer executive/visuospatial function, naming, language, abstraction, and delayed recall. Of all cognitive domains, exploratory analyses showed that only orientation was associated with 30-day adverse outcomes after adjusting for age, sex, education level, and/or American Society of Anesthesiologists status and within-domain multiplicity. Each one-point decrease in orientation score was associated with a longer length of stay (β = 0.5, 95% confidence interval [95% CI] 0.2–0.8; P $=$ $=$ 0.012) and higher adjusted odds of postoperative delirium (adjusted odds ratio [aOR] = 11.4, 95% CI 2.6–46.8; P $=$ $=$ 0.004), complications (aOR = 3.1, 95% CI 1.3–8.9; P $=$ $=$ 0.035), non-home discharge (aOR = 4.1, 95% CI 1.5–11.4; P $=$ $=$ 0.014), and composite adverse outcomes (aOR = 5.6, 95% CI 1.9–23.9; P $=$ $=$ 0.014). Orientation remained associated with postoperative delirium after adjusting for multiplicity both within and across MoCA domains (aOR = 11.4, 95% CI 2.6–46.8; P $=$ $=$ 0.031).

Conclusions

This analysis characterized preoperative domain-specific performance on the MoCA in older adults, with participants screening positive for CI exhibiting poorer performance across all cognitive domains. Exploratory findings suggested that orientation difficulties may be associated with early adverse outcomes, with postoperative delirium showing the most robust association.