$2 million grant to help UF researchers identify older adults at risk for cognitive changes after surgery

A new University of Florida study is applying a novel twist to a well-known cognitive screening test to help clinicians rapidly and accurately identify older adults who may be at risk for memory and thinking problems after major elective surgeries.

The five-year UF study is supported by a $2 million grant from the National Institute on Aging. Catherine Price, Ph.D., an associate professor of clinical and health psychology in the UF College of Public Health and Health Professions, and Patrick Tighe, M.D., M.S., an associate professor of anesthesiology in the UF College of Medicine, serve as the study’s lead investigators. The research team also includes collaborators from Boston University, the Massachusetts Institute of Technology, and Lahey Hospital and Medical Center in Burlington, Massachusetts, as well as several UF scientists.

Post-surgery decline in brain function is characterized by subtle changes in memory and the ability to learn new information and do two or more things at the same time while ignoring distractions. About 40 percent of older adults experience such difficulties immediately following major surgery and 15 percent of patients continue to have problems three months later. While scientists are still trying to understand the causes of this phenomenon, they do know that patients who have some cognitive impairment before surgery are at risk of developing more serious problems after the surgery, such as delirium and dementia.

“Health care systems currently lack an efficient mechanism for systematically screening cognition in older adults as part of presurgical medical testing,” Price said. “Not knowing an older adult patient’s cognitive function hinders the ability to intervene to reduce patients’ risk for cognitive problems associated with surgery. Certain types of cognitive problems may be reversible if identified early.”

In the new study, a simple pen and paper test that is routinely taught in medical schools will instead be administered with a special digital pen that records data at a rate of 80 times per second to capture a precise and objective measure of the patient’s test performance. The technology was developed through a 10-year collaboration involving Price and MIT colleagues Randall Davis, Ph.D., and Dana Penney, Ph.D.

The study data will be analyzed with machine learning algorithms to identify which subtle behavioral features predict post-operative complications and outcomes such as length of stay, hospital cost and readmission rates.

The researchers will also enroll older adults who are undergoing elective cardiovascular, orthopedic and abdominal surgeries to complete the digital test at specific times throughout the course of the year. T­­heir results will be compared with the test performance of a large group of older adults who are not undergoing surgery and are participating in the Framingham Heart Study, a long-term study that tracks the health of residents of Framingham, Massachusetts. The researchers hope the data they collect will help them improve rapid detection of pre-operative and post-operative cognitive impairment and subtle cognitive decline.

The goal is to provide an efficient and accurate tool that becomes part of routine clinical practice and overcomes some of the current barriers health care providers face when conducting presurgical health tests with patients, Tighe said.

“Anesthesiologists, surgeons and other perioperative health care professionals typically lack the subspecialty training necessary to conduct formal neuropsychological assessments,” he said. “These evaluations also often require considerable time and environmental considerations that are beyond the purview of a typical surgical evaluation system. This study will help health care professionals identify and categorize patients’ cognitive difficulties that may influence decisions about the timing of surgery, surgical and anesthetic techniques, and postoperative recovery plans.”