One potential tool is the digitally-acquired clock drawing test (CDT), where patients are first asked to draw a clock to a command and then copy a model of a clock. It is important, however, to identify a screening tool that can be used by medical staff and provide rapid information yet remain sensitive to subtle effects of abnormal aging. Cognitive screenings could serve as a functional biomarker to predict which patients may benefit from improved care planning thereby reducing postoperative hospital costs and stay. It is possible that older adults with even subtle cognitive vulnerabilities undergoing TAVR may remain hospitalized longer with an increased cost of care. Integrating preoperative cognitive biomarkers into the model is the next logical research approach, particularly given: (1) the abundance of research documenting the significance of preoperative cognition on postoperative outcome (2) that 54% of all surgical procedures are performed on older adults (3) prospective hospital-based studies show at least 20% of older adults electing surgical procedures have mild to moderate cognitive limitations on standardized screening metrics and (4) general surgery guidelines strongly recommend at minimum preoperative cognitive screening for older adults electing surgery. Towards improving hospital care modeling for TAVR, researchers have largely examined the predictive value of traditional metrics such as age and comorbidity on TAVR outcome costs, and more recently frailty as a predictor of hospital stay. Although TAVR is associated with reduced mortality relative to standard surgical aortic valve replacement, the procedure can still be accompanied by negative complications impacting hospital cost and stay, e.g., Tilley and colleagues reported that 23% of patients aged 60 years or older who underwent TAVR experience delirium, a preventative cause of cognitive impairment and dementia.
One relevant surgical procedure is transcatheter aortic valve replacement (TAVR), the procedure of choice relative to surgical aortic valve replacement in intermediate-risk older adult patients. Although preoperative cognitive impairments are well known predictors of negative cognitive postoperative outcomes, it remains unknown if preoperative cognitive screening metrics provide valuable predictive information relevant to hospitals providing the care for older adults electing surgical procedures.
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