INTRODUCTION Risks for postoperative cognitive dysfunction remain poorly understood. Traditional cognitive screening tools such as the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) are used for perioperative cognitive evaluation but have limited scope, whereas comprehensive in-person testing poses problems for long-term follow up.

METHODS This prospective cohort study assesses the feasibility of using a remotely performed comprehensive neurocognitive test battery, the Uniform Data Set tele-adapted neuropsychological battery version 3 (UDS v3.0 T-cog), administered at baseline and 1 week, 1 month, and 3 months postoperatively, to comprehensively study neurocognitive outcomes in older adults undergoing orthopedic joint arthroplasty. Patient satisfaction with T-cog was assessed through four survey questions evaluating technical issues, duration, willingness to participate in in-person assessment, and satisfaction with remote assessment at 3 months after surgery. Further assessment of pain and mood also included PROMIS scales, McGill Pain Questionnaire, and Pain Catastrophizing Scale, before and 3 months after surgery.

RESULTS 127 participants were enrolled, and out of 120 participants who completed baseline cognitive assessment and underwent surgery, 98 completed cognitive assessments at 3 months. At 3 months, 17% of participants showed an objective decline in cognitive function based on this comprehensive assessment. The remote assessment format was well-received with high participant satisfaction. The UDS v3.0 T-cog identified deficits in specific domains that would have been missed by brief screening instruments, supporting its values for perioperative use.

DISCUSSION This is the first study to utilize this comprehensive remote cognitive assessment tool to study long-term cognitive function. The assessment can be combined with other preoperative outcome assessments in older adults undergoing surgery.

Highlights

Current detection of perioperative cognitive outcomes in older adults rely on in-person cognitive assessments that are varied in methodology and often lack sensitivity and specificity

The UDS v3.0 T-cog identified objective cognitive decline in 17% of patients after orthopedic arthroplasty while also detecting early non-memory cognitive decline through the more comprehensive test battery with high participant satisfaction and retention, supporting remote assessment feasibility.

These findings suggest that remote comprehensive cognitive assessments are an effective tool to provide early detection and risk stratification for perioperative neurocognitive dysfunction in older patients.

Dr. Ran Schwarzkopf's disclosures are as follows: royalties from Smith & Nephew; paid consultant for Smith & Nephew and Zimmer; stock options in Gauss Surgical, Intelijoint, and PSI; research support from Smith & Nephew; editorial/governing board membership for Arthroplasty Today and Journal of Arthroplasty; and board member/committee appointments for AAOS and AAHKS. Dr. Thomas Wisniewski's disclosure: Field Chief Editor for Frontiers in Aging Neuroscience. Dr. Lisa V. Doan's disclosure: editorial services for Health Monitor Network. Dr. Jing Wang's disclosure: cofounder of Pallas Technologies, Inc. All other authors declare no conflicts of interest or relevant financial disclosures

This study is supported by the Aging Research Community (ARCO) Initiative and the Interdisciplinary Pain Research Program (IPRP) at the New York University Grossman School of Medicine. This study was also supported by NIH grant P30AG066512 (to Dr. Thomas Wisniewski).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study protocol was approved by the New York University Grossman School of Medicine Institutional Review Board (6/27/2023, #123-00664). Study procedures were conducted in accordance with the ethical standards as laid down in the Declaration of Helsinki. All participants gave written informed consent.

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All data produced in the present study are available upon reasonable request to the authors.