International Observational Study on Perioperative Cognitive Trajectories (POCD Census International/PCI)

Neuropsychological testing

Neuropsychological testing

Short neuropsychological testing

Definition according to DSM-V as proposed in Evered L et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery. Br J Anaesth, Anesthesiology, Can J Anesth, Anesth Analg, J Alz Dis, acta scandinavica anaesthesiologica (Joint Publication) 2017; Accepted, In Press. We will use an I-pad based neuropsychological test battery (CANTAB connect), and cognitive screening instruments (MOCA, Mini-Cog™ and Animal naming test on verbal fluency from ACE-R) for assessment of cognitive function, MMQ and IQ-code for self- or by proxy reported cognitive concern and ADL/IADL for assessment of functional status. Mild/major Neurocognitive Disorder measured at baseline (pre-existing NCD) 3 months and 1 year (with specifier 'POCD'), 2- and 5 years after surgery

Definition according to DSM-V as proposed in Evered L et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery. Br J Anaesth, Anesthesiology, Can J Anesth, Anesth Analg, J Alz Dis, acta scandinavica anaesthesiologica (Joint Publication) 2017; Accepted, In Press. We will use an I-pad based neuropsychological test battery (CANTAB connect), and cognitive screening instruments (MOCA, Mini-Cog™ and Animal naming test on verbal fluency from ACE-R) for assessment of cognitive function, MMQ and IQ-code for self- or by proxy reported cognitive concern and ADL/IADL for assessment of functional status. Mild/major Neurocognitive Disorder measured at baseline (pre-existing NCD) 3 months and 1 year (with specifier 'POCD'), 2- and 5 years after surgery

Patients for spinal anesthesia who consented on lumbar puncture receive biomarkers analysis from spinal fluid (beta Amyloid 1-40, beta-Amyloid 1-42, beta-Amyloid Ratio (42/40*10), phospho-TAU, Protein 14-3-3, PRPSc, TAU (Gesamt-Tau)).

Patients consented on blood sampling receive biomarker analysis from blood (Apolipoprotein E).

Comorbidities will be quantified by use of Charlson Comorbidity index

Changes in the nutritional status after elective surgery are measured by a questionnaire.

Malnutrition is measured by the Body mass index

Malnutrition is measured by weight

Malnutrition is measured by weight

The dental status is determined by tooth doctors

The composite outcome measure "Sarcopenia" is defined by the following three criteria: 1) low muscle strength (hand grip strength), 2) low muscle quantity (calf circumference and 3) low physical performance (gait speed). Criterion (1) identifies probable sarcopenia, additional documentation of criterion (2) confirms sarcopenia diagnosis, and if all criteria (1), (2) and (3) are met, sarcopenia is considered severe.

Calf circumference is measured in a standardized position and documented in centimeter.

Arm circumference is measured in a standardized position and documented in centimeter.

Adherence to Mediterranean diet (MD) is measured with a German Mediscore, could range from 0 to 9, with higher scores (6-9) indicating greater MD adherence.

Participants will be followed for the duration of hospital stay, an expected average of 7 days

Physical activity is evaluated by interviewing the Patient.

Surgical risk will be described by type and length of surgery and perioperative cardiac risk estimation as described in Anästh Intensivmed 2017; 58:349-364.

Anaesthesiological risk will be described by American Society of Anesthesiologists Classification (ASA Class)

Anaesthesiological risk will be measured by length of anesthesia

Anaesthesiological risk will be measured by type of anaesthesia

Intraoperative depth of sedation will be monitored with changes in the pattern and power spectrum of EEG-raw data measured with the Masimo SedLine® brain function monitoring for Root®, Narcotrend®, BIS™ and additionally quantified by indices [e.g. PSI or BIS-index] and burst suppression ratio.

Sedation is measured by Richmond Agitation Sedation Scale.

Sedation is measured by Richmond Agitation Sedation Scale.

Agitation describes a clinical state in which the patient may be impulsive and attempt to get out of bed, to wander, and to fall (which may lead to further injury or death) and attempt to remove IV lines, tubes, or catheters.

Postoperative delirium rate, defined according to Diagnostic and Statistical Manual of Mental Disorders (DSM-V), CAM/CAM-ICU, Nu-DESC and Chart Review.

Postoperative delirium rate, defined according to Confusion assessment method - severity(CAM-S); Delirium Rating Scale Revised (DSR-R-98), Intensive Care Delirium Screening Checklist (ICDSC) and Nursing Delirium Screening Scale (Nu-DESC).

Duration of postoperative delirium, defined according to medical evaluation, measured in days

Pain during hospital stay will be measured with the Numeric Rating Scale (NRS-V).

For patients unable of pain self-assessment (e.g. ventilated patients, patients in delirious state or patients with stroke affecting language skills) observer-rated pain scales will be applied: Behavioural Pain Scale (BPS for ventilated) and BPS-NI (for non-ventilated) patients, Critical-Care Pain Observation Tool (CPOT) during hospital stay.

Intensive care unit length of stay describes every day spent in an ICU bed.

Hospital length of stay describes every day spent in an hospital.

Perioperative anxiety will be measured with APAIS preoperatively and the Faces Anxiety Scale (FAS) and during hospital stay.

Stress is measured by Perceived Stress Questionnaire 20

Stress level is measured by stress thermometer

Anxiety will be measured with the Generalized Anxiety Disorder 7-Item Scale (GAD-7)

Depression is measured by PHQ-8. Scores represent:0-5 = mild, 6-10 = moderate, 11-15 = moderately severe, 16-20 = severe depression

Quality of sleep is measured by the Insomnia Severity Index.

Organ dysfunctions are evaluated according to the Clavien-Dindo classification of surgical complications

Prescribed regular drug intake from baseline at all follow ups including perioperative application of drugs, infusions and transfusions will be evaluated.

Quality of life will be measured with the EQ-5D-5L

Level of dependency will be measured with with ADL/IADL, single items concerning patients' living situation and the BSSS-17 (Berlin Social Support Scales).

Variables affecting performance of cognitive testings

Hospital readmission is an episode when a patient who had been discharged from a hospital is admitted again within a specified time interval.

Surgery performed to replace or compensate for a failed implant or to correct undesirable sequelae of previous surgery.

Treatment outside of the hospital in an associated facility for diagnosis or treatment.

The number of deaths in a given period.

Dementia reported as clinical diagnosis based on DSM-5 criteria for major NCD either through neuropsychological evaluation at a memory clinic or as a research diagnosis based on neuropsychological test values (CANTAB/MOCA), cognitive concern (MMQ/IQCODE) and functionality (ADL/IADL).

The incongruence questionnaire (Der Inkongruenzfragebogen)

Questionnaire on frequency of cognitively stimulating leisure activities

Spectral analysis with band power are measured by EEG at third postoperative day and delirium dependent until postoperative day 7.

Pain is measured with dolosys paintracker

Loneliness is measured with the UCLA-Loneliness-Scale (3 items)

Social support is measured with the Berliner Social-Support Skalen BSSS-17

Living situation is measured with te question: How do you live?

Obesity is measured by body mass index (BMI)

Obesity is measured by waist to hip ratio

Reading / writing weakness, hendedness, native speaker

Frailty will be measured by Fried's criteria (Physical Frailty Phenotype), Fried et al: Frailty in older adults: evidence for a phenotype. J.Gerontol.A Biol.Sci.Med.Sci. 2001; 56: M146-M156 and evaluated in a short comprehensive geriatric assessment as decribed by Birkelbach, O. et al. Warum und wie sollte ich Frailty erfassen? - ein Ansatz für die Anästhesieambulanz. Anasthesiol. Intensivmed. Notfallmedizin Schmerztherapie 52, 765-776 (2017).

Level of education (years of formal training, last occupation, ISCED-2011 and crystalline intelligence [IQ-variable calculated with NART/MWT-A or other national equivalent ] will be used to evaluate cognitive reserve.

Mehrfachwahl-Wortschatz-Intelligenztest (MWT-A) and National Adult Reading Test (NART)

Interview guide employment situation and previous professional activity adapted to Engstler (2017); Classification according to ISCO 08; Workload indices according to Kroll (2011)

Delusion proneness is measured by Peter's Delusion Inventory

History of physical activity less than 30 minutes / day (i.e. moderate increase in heart rate due to fast walking, cycling or other exercise)

Spectral analysis with band power are measured by EEG

Preoperative Cognitive Impairment (PreCI) is measured by computerized and paper pencil tests