Boston Naming Test as a Screening Tool for Early Postoperative Cognitive Dysfunction in Elderly Patients After Major Noncardiac Surgery

Abstract

Purpose

The Boston naming test (BNT), as a simple, fast, and easily administered neuropsychological test, was demonstrated to be useful in detecting language function. In this study, BNT was investigated whether it could be a screening tool for early postoperative cognitive dysfunction (POCD).

Methods

This prospective observational cohort study included 132 major noncardiac surgery patients and 81 nonsurgical controls. All participants underwent a mini-mental state examination (MMSE) and BNT 1 day before and 7 days after surgery. Early POCD was assessed by reliable change index and control group results.

Results

Seven days after surgery, among 132 patients, POCD was detected in 30 (22.7%) patients (95% CI, 15.5%-30.0%) based on MMSE, and 45 (34.1%) patients (95% CI, 26.3%-41.9%) were found with postoperative language function decline based on BNT and MMSE. Agreement between the BNT spontaneous naming and MMSE total scoring was moderate (Kappa .523), and the sensitivity of BNT spontaneous naming for detecting early POCD was .767. Further analysis showed that areas under receiver operating characteristics curves (AUC) did not show statistically significant differences when BNT spontaneous naming (AUC .862) was compared with MMSE language functional subtests (AUC .889), or non-language functional subtests (AUC .933).

Conclusion

This study indicates the feasibility of implementing the BNT spontaneous naming test to screen early POCD in elderly patients after major noncardiac surgery.

Keywords

Boston naming test mini-mental state examination postoperative cognitive dysfunction language function

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References

Evered

Silbert

Knopman

, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery. Anesthesiology. 2018;129(5):872-879.

Needham

Webb

Bryden

. Postoperative cognitive dysfunction and dementia: what we need to know and do. Br J Anaesth. 2017;119(1):115-125.

Skvarc

Berk

Byrne

, et al. Post-Operative Cognitive Dysfunction: an exploration of the inflammatory hypothesis and novel therapies. Neurosci Biobehav Rev. 2018;84:116-133.

Moller

Cluitmans

Rasmussen

, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998;351(9106):857-861.

Glumac

Kardum

Sodic

Supe-Domic

Karanovic

. Effects of dexamethasone on early cognitive decline after cardiac surgery: a randomised controlled trial. Eur J Anaesthesiol. 2017;34(11):776-784.

Steinmetz

Christensen

Lund

Lohse

Rasmussen

ISPOCD Group . Long-term consequences of postoperative cognitive dysfunction. Anesthesiology. 2009;110(3):548-555.

Bentvelzen

Aerts

Seeher

Wesson

Brodaty

. A comprehensive review of the quality and feasibility of dementia assessment measures: the dementia outcomes measurement suite. J Am Med Dir Assoc. 2017;18(10):826-837.

Van der Hoek

Nieuwenhuizen

Keijer

Ashford

. The MemTrax test compared to the Montreal cognitive assessment estimation of mild cognitive impairment. J Alzheimers Dis. 2019;67(3):1045-1054.

Kaplan

Goodglass

Weintraub

Goodglass

. Boston naming test. Philadelphia: Lea & Febiger; 1983.

10.

Cheung

Chan

. Confrontation naming in Chinese patients with left, right or bilateral brain damage. J Int Neuropsychol Soc. 2004;10(1):46-53.

11.

Lam

Kwok

Chan

, et al. Long term neurocognitive impact of low dose prenatal methylmercury exposure in Hong Kong. Environ Int. 2013;54:59-64.

12.

Lin

Chen

Lin

, et al. Confrontation naming errors in Alzheimer's disease. Dement Geriatr Cogn Disord. 2014;37(1-2):86-94.

13.

Yang

Shen

, et al. Cognitive characteristics in Chinese non-demented PD patients based on gender difference. Transl Neurodegener. 2018;7:16.

14.

Katzman

Zhang

Ouang-Ya-Qu , et al. A Chinese version of the Mini-Mental State Examination; impact of illiteracy in a Shanghai dementia survey. J Clin Epidemiol. 1988;41(10):971-978.

15.

Meyer

Huang

Chowdhury

Quach

. Adapting mini-mental state examination for dementia screening among illiterate or minimally educated elderly Chinese. Int J Geriatr Psychiatry. 2003;18(7):609-616.

16.

Culley

Flaherty

Fahey

, et al. Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients. Anesthesiology. 2017;127(5):765-774.

17.

Evered

Scott

Silbert

Maruff

. Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesth Analg. 2011;112(5):1179-1185.

18.

Rasmussen

Larsen

Houx

, et al. The assessment of postoperative cognitive function. Acta Anaesthesiol Scand. 2001;45(3):275-289.

19.

Silbert

Evered

Scott

. Incidence of postoperative cognitive dysfunction after general or spinal anaesthesia for extracorporeal shock wave lithotripsy. Br J Anaesth. 2014;113(5):784-791.

20.

Fine

. On sample size for sensitivity and specificity in prospective diagnostic accuracy studies. Stat Med. 2004;23(16):2537-2550.

21.

Berger

Schenning

Brown

, et al. Best practices for postoperative brain health: recommendations from the fifth international perioperative neurotoxicity working group. Anesth Analg. 2018;127(6):1406-1413.

22.

Benjamini

Hochberg

. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B Methodol. 1995;57(1):289-300.

23.

Leite

Miotto

Nitrini

Yassuda

. Boston Naming Test (BNT) original, Brazilian adapted version and short forms: normative data for illiterate and low-educated older adults. Int Psychogeriatr. 2017;29(5):825-833.

24.

Baldo

Arevalo

Patterson

Dronkers

. Grey and white matter correlates of picture naming: evidence from a voxel-based lesion analysis of the Boston Naming Test. Cortex. 2013;49(3):658-667.

25.

Fong

Hshieh

Wong

, et al. Neuropsychological profiles of an elderly cohort undergoing elective surgery and the relationship between cognitive performance and delirium. J Am Geriatr Soc. 2015;63(5):977-982.

26.

Kelley

Ranes

Estrada

Grandizio

. Evaluation of the military functional assessment program: preliminary assessment of the construct validity using an archived database of clinical data. J Head Trauma Rehabil. 2015;30(4):E11-E20.

27.

Jefferson

Wong

Gracer

Ozonoff

Green

Stern

. Geriatric performance on an abbreviated version of the Boston naming test. Appl Neuropsychol. 2007;14(3):215-223.

28.

Calero

Arnedo

Navarro

Ruiz-Pedrosa

Carnero

. Usefulness of a 15-item version of the Boston Naming Test in neuropsychological assessment of low-educational elders with dementia. J Gerontol B Psychol Sci Soc Sci. 2002;57(2):187-191.

29.

Gross

Jones

Fong

Tommet

Inouye

. Calibration and validation of an innovative approach for estimating general cognitive performance. Neuroepidemiology. 2014;42(3):144-153.

30.

Aniwattanapong

Tangwongchai

Supasitthumrong

, et al. Validation of the Thai version of the short Boston Naming Test (T-BNT) in patients with Alzheimer’s dementia and mild cognitive impairment: clinical and biomarker correlates. Aging Ment Health. 2019;23(7):840-850.

31.

Medvedev

Sheppard

Monetta

Taler

. The BNT-38: applying rasch analysis to adapt the Boston Naming Test for use with English and French Monolinguals and Bilinguals. J Speech Lang Hear Re. 2019;62(4):909-917.