Cognitive Assessment in Middle And Elderly Aged Patients Undergoing Non-Cardiac Surgery Using Mini Mental Status Examination Score in Tertiary Care Hospital- A Prospective Observational Study

Background: Post operative cognitive decline is more commonly seen in elderly aged patients undergoing noncardiac surgery. The Mini Mental Status Examination (MMSE) score is routinely used as a screening test to assess the cognitive status of a patient. We aimed to assess the trend in cognitive decline among middle (4059years) and elderly age (≥60 years) patients undergoing elective major non-cardiac surgery. Methods: One hundred (American Society of Anesthesiologists I,II and III ) patients aged more than 40 years were followed up at regular time intervals after obtaining written informed consent. The study group patients were divided into two based on their age namely middle age (40-59years) and elderly age (≥60 years). The cognitive testing was done at the time of pre operative assessment, 7 th day (or the time of discharge) and 3 months after surgery using MMSE score by Psychiatrist. We also collected the demographic profile along with perioperative details from the patient case sheet. Data were entered in Excel sheet and statistical analysis was done using appropriate tests. Results: The mean MMSE score in middle age group during preoperative period and at the time of discharge were 29.86±0.35 and 29.68±0.57 respectively. There was no significant change in MMSE score after 3 months of surgery ( mean MMSE 29.32±0.84) and the change in MMSE score was only 0.54 while comparing with preoperative value. While in elderly age group patients the mean MMSE scores were 28.90±1.31and 28.52±1.25 during preoperative period and at the time of discharge respectively. There was statistical difference in MMSE score 3 months after surgery between the two groups (29.32±0.84 and 28.08±1.87) with p value of < 0.0001 Conclusion: Even though MMSE score is routinely used for assessing the cognitive status of a patient it lacks specificity in detecting cognitive decline. To define postoperative cognitive decline clearly the study might include a battery of psychological tests.