Preoperative Cognitive Assessment

There is emerging evidence that preoperative cognitive dysfunction is under diagnosed and has a significant adverse impact on perioperative outcome. Preoperative cognitive impairment has emerged as the strongest predictor of the development of postoperative delirium amongst multiple risk factors (ASA classification, advancing age, poor functional status, medical co- morbidities and depression). This is of significance as delirium is a common major surgery and its occurrence is strongly associated with prolonged length of stay, the need for institutionalized care, persistent cognitive decline and all- cause mortality population, showing that any neurological postoperative morbidity is associated with a reduction in longer-term survival.

Given the implications of cognitive dysfunction in the perioperative period a coordinated multidisciplinary approach may well represent the best model of care. Closer working relationships between general practitioners, anaesthetists, surgeons and geriatricians would facilitate more comprehensive assessment and management.

General Recommendations

• Assessment of cognitive impairment should be considered in older high-risk patients during the preoperative assessment process
• Due to the high degree of overlap with frailty, further recommendations for management of this patient group are as outlined in the frailty section.