Bruno Neuner MD MSE

Charité – Universitätsmedizin BerlinCampus Virchow-Klinikum and Campus Charité MitteCharitéCenter for Anesthesiology, Operating-Room

Management and Intensive Care Medicine

Measures of cognitive impairment in large population-based

cohorts: Helpful in the clinical / ICU setting too?

Murkin, J. M., Newman, S. P., Stump, D. A., & Blumenthal, J. A. (1995). Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. The Annals of Thoracic Surgery, 59(5), 1289–1295.

Murkin, J. M., Newman, S. P., Stump, D. A., & Blumenthal, J. A. (1995). Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. The Annals of Thoracic Surgery, 59(5), 1289–1295.

Recommended Test Cognitive Domain

Trail-making A (Visual) attention and concentration and executive functions //Visual search, scanning, speed of processing, mental flexibility, and executive functions (1)

Trail-making B

Rey auditory verbal learning test (Verbal) memory

Grooved pegboard (2) Visual-motor coordination / motor skill

Recommended Cognitive Test Battery

1. Tom N Tombaugh. (2004) Trail Making Test A and B: Normative data stratified by age and education. Arch Clin Neuropsychol. 19 (2), 203-14

2. Test utilizes 25 holes with randomly positioned slots and 25 pegs with a key along one side requiring peg to be rotated to be able to fit in hole.

Rudolph JL, Schreiber KA, Culley DJ, McGlinchey RE, Crosby G, Levitsky S, Marcantonio ER. Measurement of post-operative cognitive dysfunction after cardiac surgery: a systematic review. Acta Anaesthesiol Scand. 2010 Jul;54(6):663-77

Rudolph JL, Schreiber KA, Culley DJ, McGlinchey RE, Crosby G, Levitsky S, Marcantonio ER.Measurement of post-operative cognitive dysfunction after cardiac surgery: a systematic review. Acta Anaesthesiol Scand. 2010 Jul;54(6):663-77

Cognitive assessment in epidemiologic studies

• Cognitive function in epidemiologic (observational) trials is often assessed (only) once at baseline as a predictor / confounder (among many others) of an outcome of interest

SHARE• Since 2002• Wave 1 (2004, 11 countries, 20 modules)• Wave 2 (2006-07, 14 countries, + interview with relatives

of deceased study participants)• Wave 3 (2008-09, Sharelife questionnaire covering the

impact of federal activities on individual decision making)• Wave 4 (2010-11, 19 countries, module on social

networks + in Germany: (1) Biomarker [body size / waist-hip-ration / blood pressure / cholesterol / HbA1c / inflammatory marker ] (2) insurance data (3) non-response-experiment

CAPI = computer assisted personal interview

„Cognitive Test section“

Example of a Verbal Learning Test

Comparison of cognitive assessments

Test Domain 1995-consensus SHARE-Study

Intelligence Numeracy / knowledge

MemoryRey auditory verbal learning test

Verbal learning test /Verbal fluency test

Language (Verbal fluency test)

Executive functions* Trailmaking A / B Verbal fluency test

Visuospatial Grooved pegboard

_______________ _______________ ______________

Mood state assessment (depression / anxiety)

Recommended but no questionnaire suggested

„DSM-IV“-criteria

* Problem solving, planning, organisational skills, selective attention, inhibitory control, short term memory

….. further advantages of SHARE-Battery

– Standardized, ‚open-access‘, polyglot questionnaires on

• Socio-economic status / social support (given / received)• Lifestyle (smoking / alcohol consumption / physical activity /

eating /…)• Perceived health status / life satisfaction • Comorbidites (self-reports) / medication / visual functional

status / hearing / daily activities• Health care utilization (including nursing care) / state of

insurance

– Standardized protocols of grip strength

assessment / walking test

Alternative (solely English)

• The Medical Research Council Cognitive Function and Ageing Studies (MRC CFAS I and II) on the prevalence and incidence of dementia and cognitive decline / depression and physical disability / healthy life expectancy– CFAS II initiated in 2008 (age-group 65-84) with a

planned follow-up till 2020

Conclusion I

• SHARE battery may complement the cognitve assessment as recommended in the 1995-statement for (cardiac) surgery / anesthesia

• SHARE battery offers assessment of premorbid intelligence / verbal fluency / self-rated skills / health-related behaviors / life-style / social support

Conclusion II

• SHARE battery offers a standardized mood state assessment of (potentially confounding) depression and anxiety (as recommended in the 1995-consensus

• Questionnaires / population based cross-sectional and follow-up norm data are freely available (many outcomes of Public Health relavance)

Thanks to…

• Edith Weiss-Gerlach PhD

• Henning Krampe PhD

• Leonie Kerper

• …. and to you for your attention.

bruno.neuner@charite.de

Follow-up projects of SHARE

• Irish Longitudinal Study on Ageing (TILDA)• The Longitudinal Aging Study in India (LASI)• The Japenese Study of Aging and Retirement

(JSTAR)• SHARE Israel• The Korean Longitudinal Study of Aging (KLoSA)• The Chines Health and Retirement Study

(CHARLS)• The Mexican Health and Aging Study (MHAS)

Memory• California Verbal Learning Test• Cambridge Prospective Memory Test

(CAMPROMPT)• Doors and People• Memory Assessment Scales (MAS)• Rey Auditory Verbal Learning Test• Rivermead Behavioural Memory Test• Test of Memory and Learning (TOMAL)• Test of Memory Malingering (TOMM)• Wechsler Memory Scale (WMS)

Intelligence

• Ammons Quick Test

• National Adult Reading Test (NART)

• Wechsler Adult Intelligence Scale (WAIS)

• Wechsler Intelligence Scale for Children (WISC)

• Wechsler Preschool and Primary Scale of Intelligence (WPPSI)

• Wechsler Test of Adult Reading (WTAR)

Language

• Boston Diagnostic Aphasia Examination

• Boston Naming Test

• Comprehensive Aphasia Test (CAT)

• Lexical decision task

• Multilingual Aphasia Examination

Executive functions (1)• Behavioural Assessment of Dysexecutive Syndrome (BADS)• CogScreen: Aeromedical Edition• Continuous Performance Task (CPT)• Controlled Oral Word Association Test (COWAT)• d2 Test of Attention• Delis-Kaplan Executive Function System (D-KEFS)• Digit Vigilance Test• Figural Fluency Test• Halstead Category Test• Hayling and Brixton tests• Iowa gambling task• Kaplan Baycrest Neurocognitive Assessment (KBNA)• Kaufman Short Neuropsychological Assessment• Paced Auditory Serial Addition Test (PASAT)• Pediatric Attention Disorders Diagnostic Screener (PADDS)• Rey-Osterrieth Complex Figure• Ruff Figural Fluency Test• Stroop task• Test of Variables of Attention (T.O.V.A.)• Tower of London Test• Trail-Making Test (TMT) or Trails A & B• Wisconsin Card Sorting Test (WCST)• Symbol Digit Modalities Test

Executive functions (2)• Figural Fluency Test

• Halstead Category Test

• Hayling and Brixton tests

• Iowa gambling task

• Kaplan Baycrest Neurocognitive Assessment (KBNA)

• Kaufman Short Neuropsychological Assessment

• Paced Auditory Serial Addition Test (PASAT)

• Pediatric Attention Disorders Diagnostic Screener (PADDS)

• Rey-Osterrieth Complex Figure

• Ruff Figural Fluency Test

• Stroop task

• Test of Variables of Attention (T.O.V.A.)

• Tower of London Test

• Trail-Making Test (TMT) or Trails A & B

• Wisconsin Card Sorting Test (WCST)

• Symbol Digit Modalities Test

Executive functions (3)• Pediatric Attention Disorders Diagnostic Screener

(PADDS)• Rey-Osterrieth Complex Figure• Ruff Figural Fluency Test• Stroop task• Test of Variables of Attention (T.O.V.A.)• Tower of London Test• Trail-Making Test (TMT) or Trails A & B• Wisconsin Card Sorting Test (WCST)• Symbol Digit Modalities Test