1. Bruno Neuner MD MSE Charité – Universitätsmedizin Berlin Campus Virchow-Klinikum and Campus Charité Mitte CharitéCenter 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?

2. 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.

4. Recommended TestCognitive 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.

5. 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

7. 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

9. 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

10. CAPI = computer assisted personal interview

11. „Cognitive Test section“

12. Example of a Verbal Learning Test

14. Comparison of cognitive assessments Test Domain1995-consensusSHARE-Study IntelligenceNumeracy / knowledge Memory Rey auditory verbal learning test Verbal learning test / Verbal fluency test Language(Verbal fluency test) Executive functions*Trailmaking A / BVerbal fluency test VisuospatialGrooved 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

15. ….. 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

16. 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

18. 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

19. 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)

20. Thanks to… Edith Weiss-Gerlach PhD Henning Krampe PhD Leonie Kerper …. and to you for your attention. bruno.neuner@charite.de

21. 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)

22. 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)

23. 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)

24. Language Boston Diagnostic Aphasia Examination Boston Naming Test Comprehensive Aphasia Test (CAT) Lexical decision task Multilingual Aphasia Examination

25. 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)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)Paced Auditory Serial Addition Test (PASAT) Pediatric Attention Disorders Diagnostic Screener (PADDS)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

26. 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)Paced Auditory Serial Addition Test (PASAT) Pediatric Attention Disorders Diagnostic Screener (PADDS)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

27. Executive functions (3) Pediatric Attention Disorders Diagnostic Screener (PADDS)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