The Clock-Drawing Test as a Useful Screening Assessment of Preoperative Cognitive Impairment with Readmission After Transcatheter Aortic Valve Implantation.

IF 0.9 4区医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Yonago acta medica Pub Date : 2023-08-01 DOI:10.33160/yam.2023.08.003

Tomoko Suyama, Shinobu Sugihara, Ryuji Suyama, Naoki Fukuyama, Naoki Suyama, Yuta Ito, Ryota Seto, Kaori Kinoshita, Shihori Kitae, Kinya Shirota

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Abstract

Background: Transcatheter aortic valve implantation (TAVI) has recently become more common as a treatment for severe, symptomatic aortic stenosis (AS). Cognitive impairment (CI) is strongly associated with the prognosis of TAVI patients. However, some cognitive assessments currently in use are difficult to perform routinely in the clinical setting. To easier CI evaluation, we investigated whether CI using the clock-drawing test (CDT), one part of the Mini-Cog, affects the postoperative prognosis of TAVI patients with AS.

Methods: The present study enrolled 52 patients (median age, 85 years; 28.8% male) who underwent TAVI and were discharged between 2019 and 2021. The outcome was readmission for all causes within one year of discharge and patients were grouped according to whether they were readmitted or not. Cognitive function was assessed using the Mini-Cog which combines verbal playback and CDT.

Results: Of the 52, 11 patients (21.2%) comprised readmission group, including 4 (36.4%) each for fracture and infection, and 1 (9.1%) each for heart failure, subdural hematoma, and pneumothorax. Median Mini-Cog score was lower in the readmission group than in the non-readmission group (4 vs. 5; P < 0.05). The frequency of Mini-Cog score < 3 (indicative of CI) and CDT failure were significantly higher in the readmission group than in the non-readmission group, respectively (46% vs. 7%, P < 0.01) (46% vs. 12%, P < 0.05). Both of Mini-Cog score < 3 and CDT failure were independently associated with readmission. The areas under the curve showed CDT was an indicator of readmission with similar accuracy to the Mini-Cog score < 3. Kaplan-Meier curves showed significant differences in readmission after 1 year between the 2 Mini-Cog groups with scores of < 3 or ≥ 3 points and CDT failure and success.

Conclusion: The CDT may be a very easy and simple screening assessment of preoperative CI with readmission within one year after TAVI.

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时钟绘制试验对经导管主动脉瓣置入术后再入院患者术前认知功能障碍的筛查评估。

背景:经导管主动脉瓣植入术(TAVI)最近成为一种治疗严重症状性主动脉瓣狭窄(as)的常用方法。认知障碍(CI)与TAVI患者的预后密切相关。然而，目前使用的一些认知评估很难在临床环境中常规执行。为了便于CI评估，我们研究了使用Mini-Cog的一部分时钟绘制试验(CDT)的CI是否影响TAVI合并AS患者的术后预后。方法:本研究纳入52例患者(中位年龄85岁;28.8%男性)，他们接受了TAVI，并在2019年至2021年期间出院。结果是出院一年内所有原因的再入院，并根据患者是否再入院进行分组。认知功能评估采用Mini-Cog结合言语回放和CDT。结果:52例患者中，再入院组11例(21.2%)，其中骨折、感染各4例(36.4%)，心力衰竭、硬膜下血肿、气胸各1例(9.1%)。再入院组的中位Mini-Cog评分低于非再入院组(4比5;P < 0.05)。再入院组Mini-Cog评分< 3 (CI指标)和CDT失败率分别显著高于非再入院组(46%比7%，P < 0.01)(46%比12%，P < 0.05)。Mini-Cog评分< 3和CDT失败均与再入院独立相关。曲线下面积显示CDT是再入院的指标，其准确性与Mini-Cog评分< 3相似。Kaplan-Meier曲线显示，评分< 3分或≥3分、CDT失败和成功的2个Mini-Cog组1年后再入院率存在显著差异。结论:CDT可作为TAVI术后1年内再入院患者术前CI的一种简便的筛选评估方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Yonago acta medica MEDICINE, RESEARCH & EXPERIMENTAL-

CiteScore

1.60

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Yonago Acta Medica (YAM) is an electronic journal specializing in medical sciences, published by Tottori University Medical Press, 86 Nishi-cho, Yonago 683-8503, Japan. The subject areas cover the following: molecular/cell biology; biochemistry; basic medicine; clinical medicine; veterinary medicine; clinical nutrition and food sciences; medical engineering; nursing sciences; laboratory medicine; clinical psychology; medical education. Basically, contributors are limited to members of Tottori University and Tottori University Hospital. Researchers outside the above-mentioned university community may also submit papers on the recommendation of a professor, an associate professor, or a junior associate professor at this university community. Articles are classified into four categories: review articles, original articles, patient reports, and short communications.