老年患者内窥镜镇静前后数字时钟绘制测试指标：一项探索性分析

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            贵州医科大学 麻醉与心脏电生理课题组   翻译: 马艳燕  编辑: 潘志军  审校: 曹莹          

背景:在术后阶段，监测老年患者神经认知恢复和我们出院准备情况的临床可行仪器有限，特别是在短期住院手术后。认知监测可以通过一种新颖的数字时钟绘制测试（dCDT）来改善。我们通过4 A测试（4AT）筛查认知障碍，然后在短期停留前后进行dCDT手术（内窥镜检查）。主要目的是调查dCDT是否对内窥镜检查后认知状态的改变敏感。我们还调查了术前认知状态是否影响内窥镜检查后的dCDT变量。

方法:本研究招募了100名年龄大于等于65岁的患者，在一家大都会医院接受内窥镜检查日间手术。参与者在入院后和出院前立即接受评估。我们执行4AT，然后执行dCDT的命令和复制时钟条件。该研究分析了总绘制时间（dCDT时间），并根据内窥镜检查前后建立的蒙特利尔认知评估（MoCA）标准对绘制时钟进行了评分。

结果:线性回归分析显示，在调整了术前基础dCDT指标、性别、年龄和受教育年限后，4AT分数较高（表现较差）与术后dCDT时间较长（β = 5.6，p = 0.012）相关。

结论:在4AT检测到基线认知损害的患者中，术后dCDT基于时间的变量减慢，但对于那些没有认知损害的患者则没有。我们的结果表明，使用命令模式的dCDT可能有助于检测择期内窥镜检查后65岁以上患者的认知损害。

   原始文献来源

Buckley RA, Atkins KJ, Silbert B, et al. Digital clock drawing test metrics in older patients before and after endoscopy with sedation: An exploratory analysis. Acta Anaesthesiol Scand. 2022 Feb;66(2):207-214. 

英文原文

Digital clock drawing test metrics in older patients before and after endoscopy with sedation: An exploratory analysis

Abstract 

Background: In the postoperative period, clinically feasible instruments to monitor elderly patients' neurocognitive recovery and discharge-readiness, especially after short-stay procedures, are limited. Cognitive monitoring may be improved by a novel digital clock drawing test (dCDT). We screened for cognitive impairment with the 4 A Test (4AT) and then administered the dCDT pre and post short-stay procedure (endoscopy). The primary aim was to investigate whether the dCDT was sensitive to a change in cognitive status postendoscopy. We also investigated if preoperative cognitive status impacted postendoscopy dCDT variables. 

Methods: We recruited 100 patients ≥65 years presenting for endoscopy day procedures at a single metropolitan hospital. Participants were assessed after admission and immediately before discharge from the hospital. We administered the 4AT, followed by both command and copy clock conditions of the dCDT. We analysed the total drawing time (dCDT time), as well as scored the drawn clock against the established Montreal Cognitive Assessment (MoCA) criteria both before and after endoscopy. 

Results: Linear regression showed higher 4AT test scores (poorer performance) were associated with longer postoperative dCDT time (β=5.6, p=0.012) for the command condition after adjusting for preoperative baseline dCDT metrics, sex, age, and years of education. 

Conclusion: Postoperative dCDT time-based variables slowed in those with baseline cognitive impairment detected by the 4AT, but not for those without cognitive impairment. Our results suggest the dCDT, using the command mode, may help detect cognitive impairment in patients aged >65 years after elective endoscopy.