Original researchThe prevalence of cognitive impairment in emergency general surgery

- This is the first use of the Montreal Cognitive Assessment (MoCA) is older acute surgical patients.
- Nearly 85% of this population had impaired cognition.
- This has implications for informed consent in surgical decision making.

Objectives: Rates of all surgical procedures are increasing at a faster rate than the population is ageing. However, this encouraging statistic, necessitates a robust evidence base. The epidemiological evidence base in acute general surgery in the older person is sparse. This is the first assessment of the prevalence of cognitive impairment measured using the Montreal Cognitive Assessment tool (MoCA) in acute general surgery. Methods: In three sites in Wales, England and Scotland comprising rural and urban populations, we studied consecutive patients aged over 65 years. We considered any older person admitted to the acute general surgical unit. We assessed them for baseline demographic data. They each underwent a MoCA assessment. Results: We collected data on 245 people, mean age 76.9 years (8.1, standard deviation), 136 (55.5%) were women. Of these 201 completed the MoCA test, mean score of 18.9 and median score 20 (range 0-30). There were 37 (15.1%) MoCA scores in the normal range (≥26) and 44 (18%) people were unable to attempt (or complete) the MoCA. Increasing age (p < 0.01) but not sex (p = 0.14) predicted an abnormal MoCA. Considering only the 44 people who were unable to attempt the MoCA assessment, 11 (25%) were known to have a diagnosis of dementia, 9 (20.5%) were too unwell and the remainder unable to complete the assessment to due pre-existing disability. Conclusions: In a representative UK wide population, a high proportion of older people admitted with an acute general surgical problem had cognitive impairment when assessed using the MoCA.