January 24, 2011

Neurocognitive Screening for POCD via the iPad

Sarah Waring and Emily Whitaker

Advised by: Dr. James L. Blair, VUMC Anesthesiology Dept.

Project Advisor

James L. Blair, OD

Assistant Professor, VUMC Department of Anesthesiology

Looking to develop pre-op screening for brain function using imaging and neurocognitive tests

January 24, 2011

January 24, 2011

Overview of POCD

Cognitive Dysfunction impairment of vital mental processes After surgery with anesthesia post operative cognitive dysfunction (POCD)Most common in elderly patients• Affects perception, memory, and information

processing• Problems can persist for several months• Impedes activities of daily living (ADL)

January 24, 2011

Overview of Neurocognitive Tests

Stroop test• Assesses concept shifting ability and executive function• Name ink color, not the word• Example:

http://www.cs.dartmouth.edu/farid/illusions/stroop.html

Easy to read ink = word

Trickier ink ≠ word

January 24, 2011

The Problem

“Comprehensive” pre-operative screening neglects brain• All other major organs are tested

Elderly patients often end up with some degree of POCD• Causes need for assistance with ADL• Causes increased mortality risk for next year

January 24, 2011

Current “Solutions”

Neurocognitive testing (NCT) after surgery to assess mental functions• One week and three months post-surgery

These tests determine presence of POCD• Accuracy without a pre-op baseline?

January 24, 2011

Group Purpose

A pre-operative test of mental function is needed• MRI/DTI/fMRI• Neurocognitive testing (NCT)

Values can be obtained for baseline• Physiological• Neurocognitive abilities

Can NCT be a screening tool for high risk of POCD?• Dr. Blair’s upcoming study will compare NCT results to

physiological changes

January 24, 2011

Group Objective

Create an iPad program that will be used to administer a battery of neurocognitive tests as part of the pre-op screening process• Must be: user friendly, in touch screen format,

easy to administer, and take approx. 10 min.• Develop accurate scoring methods for program• Stroop test to start; other tests added later

Why an iPad?

More portable than a laptop• Lightweight• Don’t have to open/close

Longer battery life

Touch screen• Easy to use, especially for the elderly

Instant start-up

January 24, 2011

January 24, 2011

Completed Work

Met with Dr. Blair to discuss overall project objectives• Received project protocol

Decided to focus initially on Stroop test• Research into Stroop test, both paper- and

computer-based versions

Research into POCD

Research into iPad programming

January 24, 2011

Current Work

Initial program coding

Research into relevant neurocognitive tests• Searching for computerized versions of Stroop

test, “finger tapping,” JLO, and HVLT

Research into licensing of tests

January 24, 2011

Future Work

Continue to meet with Dr. Blair to discuss our role in project

Determine appropriate scoring method for Stroop test

Finish program coding

Begin testing

Administer to patients and test program performance

Long Term Implications

iPad format: • Combination of multiple tests into one program

cuts costs• Easy transfer of data for analysis

Scoring algorithm: • Results calculated quickly• Data all in the same format• Trained proctor not necessary

January 24, 2011

Long Term Implications

Decrease number of cases of post-operative cognitive dysfunction

Decrease lawsuits associated with POCD

Gain more knowledge of POCD/how surgery and anesthesia affect the brain

January 24, 2011

January 24, 2011

References

Hanning CD. Postoperative cognitive dysfunction. Br J of Anaesth. Jan 2005;95(1):82-87

Monk TG, Weldon BC, Garvan CW, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. Jan 2008;108(1):18-30

Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. Jan 2005;100(1):4-10