JMIR Publications

ABSTRACT

Background Older adults undergoing surgery face increased risks of postoperative neurocognitive disorders which impair cognitive functions. Analog neurocognitive tests are commonly used, but digital tests offer faster, more accessible assessments. The overall aim was to evaluate the feasibility of a digital neurocognitive test battery. Secondary aims were to assess its usability, acceptability, perceived value, estimate recruitment and retention, and to assess trajectories of neurocognitive outcomes, including depression, functional capacity and quality of recovery. Methods A non-randomized feasibility study was conducted on older adults undergoing abdominal surgery. Acceptability, perceived value, and usability were explored through semi-structured interviews with patients and nurses, and the System Usability Scale. Recruitment and retention were measured using patient logs. Neurocognition was assessed with a digital neurocognitive test battery (CERAD, TMT A+B, Stroop, SDPT) and the Nursing Delirium Screening scale and depression with the Geriatric Depression Scale. Functional status was measured using World Health Organization Disability Assessment Schedule, frailty was evaluated with the Clinical Frailty Scale, and postoperative recovery with the Swedish Quality of Recovery questionnaire. Quantitative data were analyzed using descriptive statistics and non-parametric tests and qualitative data with content analysis. Results The test battery was feasible, acceptable and had a very good usability: System Usability Scale mean score was 87 (SD=17.9, 95% CI: 78.9-95.2), and the progression criteria warranting a full-scale trial were met. Recruitment spanned over 1.5 years and twenty-four patients were included, with a mean age of 77 years (range 63-90), and 56% were women. The majority underwent laparoscopic colorectal surgery for cancer. Three patients developed postoperative delirium for one day only. No patient developed delayed neurocognitive recovery or mild/major neurocognitive disorder at the postoperative follow-ups. In the qualitative data, both nurses and patients found the test battery to be important for assessing cognitive function, as well as being easy to use and understandable. Conclusions The digital neurocognitive battery was found to be feasible, acceptable, usable and with a high perceived value. However, the 1.5-year recruitment period was not feasible and needs to be considered in a larger trial.