Objective:

To evaluate whether, among ≥65 years old people, a ≥2 point decline in the Montreal Cognitive Assessment (MoCA) 1 year after noncardiac surgery is associated with patient-important outcomes.

Background:

NeuroVISION was an international prospective cohort study of 1114 patients, ≥65 years old, undergoing elective noncardiac surgery. In NeuroVISION, 30.3% of patients had a ≥2 point decrease in MoCA from baseline to 1 year after surgery. A ≥2 point MoCA decrease has been associated with cognitive decline based on formal neuropsychological testing. However, there is paucity of data on its association with patient-important outcomes.

Design/Methods:

NeuroVISION participants had MoCA, Lawton iADL, and EQ-5D questionnaires administered at baseline and 1 year after surgery. The iADL score was defined as the number of instrumental activities in which patients were independent (range 0-8). At 1 year participants also reported whether they had had any fall in the previous year. We performed multivariable regression analyses adjusting for age, sex, and baseline scores. 

Results:

At baseline, the median iADL score of NeuroVISION participants was 8 (interquartile range 7-8). At 1-year, patients with ≥2 point MoCA decline reported a greater decline in iADL (adjusted beta coefficient -0.20, 95% CI -0.36 to -0.05; p=0.010) and in EQ-5D VAS scores (adjusted beta-coefficient -2.90, 95% CI -5.08 to -0.73; p=0.009) than patients without. 22.2% of the patents with versus 12.1% of patients without a ≥2 point MoCA decline lost independence in ≥1 iADL (adjusted odds ratio 1.93, 95% CI 1.35-2.76, p<0.001). At 1 year, patients with a ≥2 point MoCA decline reported more frequently ≥1 fall (14.9% versus 10.2%), and a higher number of falls (adjusted incident risk ratio 1.76, 95% CI 1.28 – 2.40).

Conclusions:

In the large NeuroVISION cohort, a ≥2 point MoCA decline 1 year after noncardiac surgery was not only frequent but also associated with functional decline.