Non-invasive method to predict rates of post-operative cognitive problems

Unmet Need

Older adults are at a higher risk of cognitive dysfunction after surgery, with postoperative delirium (POD) being the most common disorder. POD is characterized by inattentiveness and is seen in 70-80% of intensive care patients. Preoperative dementia is a significant predictor, with 10% of these patients developing POD. Patients experiencing cognitive decline stay 5-10 days longer in the hospital and may have poor long-term cognitive functioning post-surgery, often requiring placement in nursing homes or rehabilitation facilities. Predicting the likelihood of developing POD is challenging, as even seemingly "healthy" patients may display inattention after surgery. Although the exact cause of post-surgery cognitive dysfunction is still unknown, a significant predictor is the pre-existence of cognitive impairment. Screening tests for cognitive impairment have low accuracy for mild levels of impairment. These tests sample language skills, short-term recall, and time-place orientation. Patients can compensate for these functions, leading to test inaccuracy. There is a need for an objective method to assess and predict the risk of cognitive dysfunctions after surgery, especially with the increasing age of the surgical population.

Technology

Duke inventors developed a non-invasive method to accurately predict rates of post-operative cognitive problems in patients over 60. This innovative approach offers health providers an objective and reliable screening tool that leverages direct, fixed brain metrics to identify patients at risk of developing POD. Specifically, the technology employs electroencephalography (EEG) to measure brain activity while the patient performs a simple task involving opening and closing of the eyes. This task modulates brain activity in the 8 to 13Hz frequency band known as alpha oscillations. Inventors demonstrated that the strength of these alpha oscillations during the task predicts the risk of developing POD. The possibility of compensation is eliminated because this activity signature of the brain is an automatic response. This was demonstrated in a cohort of 71 patients over the age of 60, apparently cognitively normal. This screening test enabled prediction of patient risk of developing POD, representing an exciting opportunity to enhance post-operative patient care and improve overall outcomes.

Other Applications

This technology could also be adapted to detect the risk or likelihood of developing other cognitive disorders associated with attention-related functions.

Advantages

• The test provides more accurate screening for post-operative cognitive problems by utilizing an automatic response that cannot be compensated against.
• EEG is non-invasive and offers insight into the internal state of the brain, leading to more accurate screening.
• The test can identify the likelihood of experiencing post-operative cognitive dysfunction and the extent to which individuals may experience such deficits.