INTRODUCTION
Currently similar to the world demographic structure, the population of
Turkey is rapidly aging, and in 2023, it is estimated that the number of
people over 65 will rise to 8.87 million (10.2% of the total
population)1. Therefore, it can be predicted that
anesthesiologists will have to deal more with elderly patients in the
near future. Anesthesiologists encounter many problems in elderly
patients, who have reduced efficacy of physiological functions.
Postoperative pulmonary, cardiovascular, and renal complications are
more likely to occur and adversely affect outcome in elderly
patients2. In addition, postoperative cognitive
dysfunction (POCD) is another frequent complication associated with
increased morbidity, mortality, and reduced quality of
life2,3.
Most POCD studies have focused on cardiac or non-cardiac major surgery,
and the incidence or severity of POCD may vary depending on the type of
surgery, cognitive assessment time, POCD definition, and
neuropsychological testing tools4-8 . Cognitive
decline is usually noticed by the patient’s family and can also be
detected by comparison of preoperative and postoperative
neuropsychological testing. Despite the importance of POCD, for elderly
patients undergoing elective surgical procedures, evaluation of
cognition is often overlooked9. There are few studies
of POCD in minor surgical procedures and outpatient cases in elderly
patients, although the minor surgeries accounts for a large proportion
of the surgical burden10-12 . Certain negative
features of the hospital environment, such as noise and preoperative
anxiety, may impair cognitive functions in elderly patients, even in
minor and outpatient surgeries10,11 .
The Mini Mental State Examination (MMSE) is a widely used cognitive
assessment tool to detect POCD in multiple cognitive domains, including
orientation, registration, attention and calculation, immediate recall,
language, short-term memory, and construct ability. The time required
for examination is 5–15 minutes, but it has high specificity and low
sensitivity to detect mild cognitive impairment13-15 .
On the other hand, the Montreal Cognitive Assessment (MoCA) is a new
cognitive screening tool for multiple cognitive domains, including
short-term memory, visuospatial skills, executive function, attention,
concentration and working memory, language, and orientation. The MoCA
has high sensitivity and specificity to detect patients with mild
cognitive impairment performing in the normal range on the
MMSE15-17.
In this prospective blinded observational study, we aimed to compare
general and spinal anesthesia in terms of early postoperative cognitive
decline and to determine the burden of this decline in elderly patients
after elective minor surgery (inguinal herniorrhaphy). Our hypothesis
was that the MoCA can detect more elderly patients with cognitive
decline, even in the neuraxial anesthesia group.