Post-Operative Cognitive Dysfunction Screening Using Neurocognitive Tests

NCIIA Grant Proposal

VanderbiltUniversity

11 November 2010

Sarah Waring

Emily Whitaker

Abstract

The purpose of this project is to design and code an iPad program which will:

  • Consist of up to three neurocognitive tests
  • Administer tests to elderly patients before surgery to screen for risks associated with POCD
  • Be presented in an easy to use touch screen format

Introduction

Cognitive dysfunction is defined as the impairment of the mental processes required for every day living – perception, memory, and information processing (Hanning 2005). When this type of cognitive decline occurs following a surgery, we call it postoperative cognitive dysfunction (POCD). Manifestations of POCD can include memory lapses, lack of problem solving abilities, difficulty retaining information, and the sudden inability to perform tasks that were previously easy. Generally, various neurocognitive tests for POCD are administered one week and three months post-surgery. Elderly patients are at the highest risk of developing POCD. Also, the majority of POCD cases result from cardiopulmonary bypass surgery (CPB) rather than from non-cardiac surgery (Hanning 2005). The development of a pre-operative battery of neurocognitive tests to screen for patients at a high risk of POCD would be of great use. We want to develop a computerized program that can be easily used to administer these neurocognitive tests to elderly patients via a touch screen format.

History and Context

We have begun researching various neurocognitive tests to use in our iPad program, namely the Stroop Color Word Test, the Hopkins Verbal Learning Test – Revised (HVLT-R), and the Wechsler Adult Intelligence Scale (WAIS-III) Digit Symbol test. Each of these tests has already been adapted, by various companies, for computer-based administration.

Team

The team members are Sarah Waring and Emily Whitaker. The outside advisor for the project is James L. Blair, DO.

Workplan and Outcomes

Our goal is to create a program for the iPad that will be used to administer up to three neurocognitive tests to elderly patients before surgery in order to assess their risk for POCD. Each test should be in a user friendly, simple, touch screen format. Since each of the tests being considered – the Stroop test, HVLT-R, and WAIS-III – for the iPad program has already been successfully adapted for computer-based administration by other parties, we should be able to successfully program them.

Evaluation and Sustainability Plan

We will have succeeded if the program we create runs as desired, administering neurocognitive pre-operative tests to patients. The data provided will also need to be statistically valid, matching what we would get from using paper-and-pencil versions of the same tests.

Appendix

Project Timeline

Gantt chart:

Task / Duration / Oct-10 / Nov-10 / Dec-10 / Jan-11 / Feb-11 / Mar-11 / Apr-11
Research / 4 mo. /
Programming
Stroop / 1 mo. /
HVLT-R / 1 mo. /
WAIS-III / 1 mo. /
Debugging
Stroop / ? /
HVLT-R / ?
WAIS-III / ?
User testing / ~1-2 mo. /

Budget

$500 - 1 iPad

$500 - 3 Neurocognitive tests

References

Hanning, C. D. "Postoperative Cognitive Dysfunction." British Journal of Anaesthesia 95.1 (2005): 82-87. Print.