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>50% of patients undergoing #VascularSurgery may have underlying #CognitiveImpairment
Key finding of our new paper published in @EJVES_ESVS
https://authors.elsevier.com/a/1cYbk_OXZNznGR
Why does this matter?
@GDresearchgroup @UoLCVS @robsayers17 @VictoriaHaunton #SystematicReview #MetaAnalysis
Key finding of our new paper published in @EJVES_ESVS
https://authors.elsevier.com/a/1cYbk_OXZNznGR
Why does this matter?
@GDresearchgroup @UoLCVS @robsayers17 @VictoriaHaunton #SystematicReview #MetaAnalysis
Individuals with mild cognitive impairment have detectable deficits in one or more cognitive domain on testing and will usually have noticed (or their family noticed) a change in their memory, thinking or function. 
Some will go on to develop dementia.
Some will go on to develop dementia.
We included studies that used a cogntive assessment tool in people with vascular surgery disease (e.g. #PAD #AAA) that was symptomatic or >threshold for surgery (ie those that may be offered vascular intervention)
We made A LOT of data requests - thanks to those that replied!
We made A LOT of data requests - thanks to those that replied!
The calculated prevalence varied greatly (lots of heterogeneity of studies)
In the limited meta-analyses the pooled prevalence of #CognitiveImpairment using the #MoCA of patients undergoing vascular surgery was 61% (95%CI 48% - 71%)!
In the limited meta-analyses the pooled prevalence of #CognitiveImpairment using the #MoCA of patients undergoing vascular surgery was 61% (95%CI 48% - 71%)!
This is likely to be an UNDER-estimate of all those considered for vascular surgery. Patients with cognitive impairment are less likely to be involved in research and these studies did not include patients managed conservatively.
This isn't a surprise...
The pathophysiology of #CognitiveImpairment is complex and heterogeneous but there's often and underlying vascular component and it's strongly associated with cardiovascular disease.
The pathophysiology of #CognitiveImpairment is complex and heterogeneous but there's often and underlying vascular component and it's strongly associated with cardiovascular disease.
Why does it matter?
Patients with worse cognitive function are more likely to have post-operative delirium.
Also under-recognised but a bad post-op complication associated with worse mortality and loss of independence.
Patients with worse cognitive function are more likely to have post-operative delirium.
Also under-recognised but a bad post-op complication associated with worse mortality and loss of independence.
#CognitiveImpairment may also be associated with other post-op complications, increased length of stay etc.
BUT the research in vascular surgery is surprisingly sparse given the high prevalence.
More research in this area please!
(we're doing some...) https://bmjopen.bmj.com/content/9/9/e031257
BUT the research in vascular surgery is surprisingly sparse given the high prevalence.
More research in this area please!
(we're doing some...) https://bmjopen.bmj.com/content/9/9/e031257
We recommend pre-op cognitive screening in this paper
We do ECGs, Echos and cardiac stress tests to check
function
We do CXRs and spirometry to check
function
We do CPEX
to check fitness
Why not also check function?
Lots of cognitive screening tools available
We do ECGs, Echos and cardiac stress tests to check
functionWe do CXRs and spirometry to check
functionWe do CPEX
to check fitnessWhy not also check
function?Lots of cognitive screening tools available
But if we find #CognitiveImpairment what could we do about it?
1. Refer to a memory clinic
2. Consider deprescibing (
unecessary
)
3. Consider operative strategy (limited evidence avoiding GA and endovascular interventions may have risk of delirium)
1. Refer to a memory clinic
2. Consider deprescibing (
unecessary)3. Consider operative strategy (limited evidence avoiding GA and endovascular interventions may have
risk of delirium)
I'm sure others would have some excellent ideas also!
@JThillainadesan @JKDhesi @A_MacLullich @VictoriaHaunton @AmyLCrees @DrPhilipBraude @POPS_GSTT @scfn_frailty
@JThillainadesan @JKDhesi @A_MacLullich @VictoriaHaunton @AmyLCrees @DrPhilipBraude @POPS_GSTT @scfn_frailty
A huge thanks to my co-authors who did a lot of work towards this! 
@AndrewNickinson @bernadetab2 @sarahnzari @CoralJPepper @harjrayt @VictoriaHaunton @robsayers17
And thanks again to everyone who shared data!
@AndrewNickinson @bernadetab2 @sarahnzari @CoralJPepper @harjrayt @VictoriaHaunton @robsayers17
And thanks again to everyone who shared data!
Here's a great explainer of what #CognitiveImpairment is and why it matters in vascular surgery by @coughlin_pa and colleagues also recently published in @EJVES_ESVS here 
https://www.ejves.com/article/S1078-5884(20)30907-2/fulltext
https://www.ejves.com/article/S1078-5884(20)30907-2/fulltext
Generous commentary of our paper in the @EJVES_ESVS also! https://www.ejves.com/article/S1078-5884(20)31119-9/fulltext
https://www.ejves.com/article/S1078-5884(20)31119-9/fulltext
