Cognitive Monitoring in Planned Arthroplasty Surgery

CogTrack™ :

• This is an online validated tool to assess cognition that takes approximately 20 minutes to deliver and can be done remotely by the patient provided they have a computer with keyboard that can connect to the internet.
• The first two assessments done will be training for the patient to gain familiarity and will not count as study data.
• Scores are returned in 9 relevant domains
• Attention Intensity Index, a composite score of reaction times from 3 different tasks will be the primary quantitative endpoint
• Scores are not released to the patient or the assessor: results are uploaded to a secure database under a unique study code. Therefore, data will remain anonymous to the researchers of Wesnes Cognition Ltd. However, the clinical research team will be able to link the data to demographic and other data collected. Password protection on all databases maintains confidentiality at all times.

• To detect patients with delirium
• The confusion assessment method (CAM)1 is widely adopted as a validated way to diagnose delirium, including in the post-operative period. However, in the clinical setting it can be challenging to deliver due to requirement of interviewer training and variation in application.
• A new 3-minute diagnostic assessment, the 3D-CAM, has been developed and validated as a diagnostic assessment with high sensitivity and specificity for delirium.
• It is important to identify those patients with delirium as this is often short-lived but may have longer term consequences.

Tools scale consists of delirium being present or absent

• To detect patients with possible dementia
• This is a widely used tool for the initial assessment of possible dementia. Each question on the IQCODE is scored from 1 to 5. A score of 3 means that the subject is rated on average as 'no change'. A score of 4 means an average of 'a bit worse'. A score of 5 an average of 'much worse'.

The IQCODE result is achieved by adding the score for each question and dividing by the number of questions. For the short IQCODE, divide by 16.

A cutting point of 3.31/3.38 for dementia achieves a balance of sensitivity and specificity.

• To categorise patients as potentially being distracted, or not, by pain from performing the CogTrack™ test
• Pain may affect cognitive processes and motivation. Therefore, it is important to ascertain levels of pain that patients experienced during the study and how this has affected their activity.

VAS score: 0 (no pain)- 10 (worst pain)

• Opioids and sedatives may affect cognition and hence we will be collecting this information alongside the cognitive testing. Opioid consumption will be converted to oral morphine equivalent doses (Appendix 7). Analgesics tend to have their highest pharmacological activity for the first few hours after a dose, hence the 6 hour window
• This information will be gathered as part of the online CogTrack™ assessment using a free text box for participants to enter the drugs and doses they have taken in the preceding 6 hours
• It is important this information is collected at each CogTrack™ assessment

• Mood may affect someone's motivation and ability to do some of the assessments
• We will therefore include a simple validated scale of mood, which will form part of the CogTrack™ cognitive assessment.
• This is quick to complete and by having it as part of the online package it reduces burden on patients as well as researchers.

• Assess how patients subjectively perceive any cognitive changes when compared to objective measures.

• Clock drawing has been used extensively in the study of cognitive changes. It assesses a range of cognitive functions, is relatively quick to administer (approximately 5 minutes) and acceptable to patients.

A score of 0-3 is given depending of the presence of certain features of the performed task.

Scale of marking 0-3