1. December 7, 2010 Neurocognitive Screening for POCD via the iPad Sarah Waring and Emily Whitaker Advised by: Dr. James L. Blair, VUMC Anesthesiology Dept.

2. December 7, 2010 Overview of POCD Cognitive Dysfunction  impairment of vital mental processes After surgery with anesthesia  post operative cognitive dysfunction (POCD) Etiology unknown More common in elderly patients Affects perception, memory, and information processing Problems can persist for several months Impedes activities of daily living (ADL)

3. December 7, 2010 Overview of Neurocognitive Tests Stroop test Developed at Vanderbilt! Assesses concept shifting ability and executive function Example: http://www.cs.dartmouth.edu/farid/illusions/stroop.html First two lines are easy to read  ink = word Now it gets tricky  ink ≠ word

4. December 7, 2010 The Problem “Comprehensive” pre-operative screening neglects brain All other major organs are tested If communicating Elderly patients often end up with some degree of POCD Causes need for assistance with ADL Causes increased mortality risk for next year

5. December 7, 2010 Current “Solutions” Neurocognitive testing (NCT) after surgery to assess mental functions One week and three months post-surgery These tests determine presence of POCD Accuracy without a pre-op baseline?

6. December 7, 2010 Group Purpose A pre-operative test of mental function is needed MRI/DTI/fMRI Neurocognitive testing (NCT) Values can be obtained for baseline Physiological Neurocognitive abilities Can NCT be a screening tool for high risk of POCD? Upcoming study will compare NCT results to physiological changes

7. December 7, 2010 Group Objective Create an iPad program that will be used to administer a battery of neurocognitive tests as part of the pre-op screening process Must be: user friendly, in touch screen format, easy to administer, and take approx. 10 min. Develop scoring methods for program Stroop test to start; other tests added later

8. December 7, 2010 Completed Work Met with Dr. Blair to discuss overall project objectives Received project protocol Decided to focus initially on Stroop test Research into Stroop test, both paper- and computer-based versions Research into POCD Research into iPad programming

9. December 7, 2010 Current Work Initial program coding Research into relevant neurocognitive tests Searching for computerized versions of Stroop test, “finger tapping,” JLO, and HVLT Research into licensing of tests

10. December 7, 2010 Future Work Continue to meet with Dr. Blair to discuss our role in project Determine appropriate scoring method for Stroop test Finish program coding Obtain iPad and begin testing Administer to patients and test program performance

11. December 7, 2010 References Hanning CD. Postoperative cognitive dysfunction. Br J of Anaesth. Jan 2005;95(1):82-87 Monk TG, Weldon BC, Garvan CW, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. Jan 2008;108(1):18-30 Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. Jan 2005;100(1):4-10