Study Finds Neurocognitive Dysfunction Underdiagnosed

New research finds that the problem of undiagnosed neurocognitive dysfunction (NCD) in total joint arthroplasty patients is high and may impact the recovery period.

“Prevalence of Neurocognitive Dysfunction and Its Effects on Postoperative Outcomes in Total Joint Arthroplasty,” appears in the February 2018 edition of The Journal of Arthroplasty.

James Slover, M.D., an associate professor of orthopedic surgery at NYU Langone Health, and clinical site chief at NYU Langone Orthopedic Hospital, co-author of the study, told OTW, “I have seen some patients who have some issues with apparent neurocognitive dysfunction postoperatively in whom I had no preoperative diagnosis or sense of its presence.”

“This topic has been more commonly discussed in the hip fracture population, which is a frail elderly group, however not as much attention has been paid to the typical TJA [total joint arthroplasty] population.”

The authors wrote, “Ninety-nine consecutive patients were prospectively enrolled. Nearly 54% were identified as neurocognitively deficient on at least 1 of the 3 tests. There was a statistically significant prevalence of NCD in patients older than 60 years when compared to normative controls for RAVLT [Rey Auditory Verbal Learning Test].”

“Patients with depression or an American Society of Anesthesiologist score of 3 were 5 times as likely to have NCD, while patients with a body mass index between 20-30 kg/m² were 5 times less likely to have NCD. Furthermore, patients identified as NCD preoperatively were significantly more likely to be transferred to the intensive care unit (48% vs 14%) and fail physical therapy (64% vs 17%), respectively.”

Dr. Slover told OTW, “These patients progress more slowly and need more support in the initial postoperative period. Specifically, there were statistically significant increases in ICU [intensive care unit] admission rates and failure to progress in physical therapy.”

“Therefore, we need to find clinically useful ways to identify these patients before surgery so that appropriate support measures can be implemented and strategies to minimize the effects of surgery can be designed and evaluated. The prevalence of undiagnosed neurocognitive dysfunction in TJA patients is high and this may impact their recovery period. Therefore, if we can identify patients prior to surgery, more careful attention to postop care and additional resources will be needed.”