BEGIN:VCALENDAR VERSION:2.0 PRODID:Linklings LLC BEGIN:VTIMEZONE TZID:America/Chicago X-LIC-LOCATION:America/Chicago BEGIN:DAYLIGHT TZOFFSETFROM:-0600 TZOFFSETTO:-0500 TZNAME:CDT DTSTART:19700308T020000 RRULE:FREQ=YEARLY;BYMONTH=3;BYDAY=2SU END:DAYLIGHT BEGIN:STANDARD TZOFFSETFROM:-0500 TZOFFSETTO:-0600 TZNAME:CST DTSTART:19701101T020000 RRULE:FREQ=YEARLY;BYMONTH=11;BYDAY=1SU END:STANDARD END:VTIMEZONE BEGIN:VEVENT DTSTAMP:20240325T185835Z LOCATION:Salon A-3 DTSTART;TZID=America/Chicago:20240326T093700 DTEND;TZID=America/Chicago:20240326T100000 UID:HFESHCS_2024 International Symposium on Human Factors and Ergonomics i n Health Care_sess133_INDLEC124@linklings.com SUMMARY:What Medical Interventions Create the most Risk for Cognitive Impa irment? DESCRIPTION:Oral Presentations\n\nMark Chignell (University of Toronto, Ce ntivizer Inc.); Alyssa Iglar (University of Toronto); Trevor Hall (Health Insurance Reciprocal of Canada); J. Bruce Morton (Western University); and Jacques Lee (Schwarz/Reisman Emergency Medicine Institute)\n\nCognitive i mpairment is a significant patient safety issue. Early identification of c ognitive impairment followed by timely medical intervention will increase the quality of life and prevent patient safety incidents. Using serious ga mes to assess cognitive impairment has shown benefit in practice. There is an opportunity identify cognitive impairment in practice using cognitive serious games. Psychometric validation of such cognitive serious games in clinical settings, and wise-practices to support the adoption and implemen tation of cognitive assessment games, are needed. \n\nThe World Health Or ganization (WHO) has proposed that functioning, rather than the presence o r absence of a given disease or condition, be the most important marker of healthy aging, which it defines as “the process of developing and maintai ning the functional ability that enables well-being in older age” (Clegg e t al., 2013). Developing and implementing successful interventions to main tain cognitive function during aging will require concerted efforts from a range of stakeholders (Coley et al., 2022). \n\nHealthcare can combat ris ing levels of cognitive impairment, as people get older, by ensuring that brain health is not harmed unnecessarily by medical interventions. In this presentation we will review some key medical interventions that have been found to create risk of cognitive impairment. We will then identify insu fficient monitoring of cognitive status as an impediment to better managem ent of cognitive status in patients as they receive treatments, and we wil l propose a way forward with cognitive assessment games. \n\nMany research studies have identified chemotherapy used in cancer treatment as a source of cognitive impairment. Schagen et al. (2022) state that “Chemotherapy-i nduced cognitive impairment is multifactorial: different molecular mechani sms result in blood–brain barrier disruption, inflammation, accelerated ce llular senescence and neuronal stem cell abnormalities, all of which lead to cognitive impairment.” Schagen et al. then went on to say: “neuropsycho logical monitoring is not yet standard practice in most cancer centres, cl inicians frequently learn of potential cognitive dysfunction through patie nt self-reports in clinics or on questionnaires.” Clearly a system that re lies on delayed patient self-reports is not monitoring cognitive status ad equately. \n\nRadiotherapy used to treat brain cancers has also been impli cated as a source of cognitive impairment. Neurological side effects of cr anial irradiation have been reported to occur in 50–90% of adult patients (Greene-Schloesser and Robbins, 2012).\n\nCognitive impairment after surge ry is sufficiently prevalent that there is a special term for it, i.e., po stoperative cognitive dysfunction (POCD). Li et al. (2022) stated that: “ [POCD] is a common neurological complication following surgery and general anesthesia, especially in elderly patients.” Elevated risk of cognitive i mpairment has also been found to occur with kidney dialysis, and with a va riety of medications including anticholinergics, sedatives, opioids, and a ntipsychotics. \n\nOne motivation for more use of cognitive assessment in healthcare is to avoid loss of cognitive status due to medical interventi ons. Another motivation is to use cognitive assessments to diagnose and mo nitor various neurological and psychiatric conditions, including dementia, delirium, and traumatic brain injuries. Commonly used tests in the clinic al setting include the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and the Confusion Assessment Method (CAM). \n\ nExisting clinical tests are typically paper-based and require a trained a dministrator. They tend to have limited repeatability (with only one, or a few questionnaire forms), and they tend to be uninteresting for the parti cipant. Since the administration of clinical tests is relatively costly, t hey are used less frequently than they should be. In addition, most tests are designed to make a major categorical decision (e.g., does the patient have mild cognitive impairment, or does the patient have dementia, or deli rium?) and are not well suited to tracking more subtle, but still importan t, changes in cognitive status. \n\nDelirium is an important target for im proved cognitive assessment because recognition of delirium in the Emergen cy Department (ED) using clinician gestalt is poor, with rates between 16% and 35% (Lewis et al., 1995). Patients discharged with unrecognized delir ium have greatly increased risk of near-term mortality compared to non-del irious patients (Kakuma et al., 2003). In a meta-analysis carried out by Goldberg et al. (2020), delirium was found to be significantly associated with long-term cognitive decline in both surgical and nonsurgical patients . Delirium is also quite prevalent in hospitals and long-term care homes. For instance, delirium affects 7% to 10% of older Emergency Department pa tients (Lee et al., 2019). In their study, Lee et al. found that 14/16 old er ED patients with delirium were able to use their serious game for cogni tive assessment, with the game showing potential to act as a sensitive scr eening tool to identify older ED patients with clinically unrecognized del irium. \n\nMany cognitive assessment games have been developed in recent y ears (e.g., Lumsden et al., 2016), but they often fail to utilize psychome tric methods such as convergent validation with standard psychological tas ks requiring specific cognitive abilities (Zhang and Chignell, 2020).\n\nI n our proposed conference presentation we show that loss of cognitive stat us is a pain point in healthcare and that existing methods of cognitive as sessment need to be supplemented with cognitive assessment games that can provide more efficient, and sensitive, testing. Challenges may exist with the implementation of cognitive assessment games in healthcare where, as a n example, there are incumbent methods and relatively low levels of curren t interest in changing the paradigm when it comes to cognitive assessment. We will conclude our presentation with a suggested roadmap for validatin g and implementing cognitive assessment games in healthcare contexts.\n\nR eferences\n\nBorchers, F., Spies, C.D., Feinkohl, I., Brockhaus, W.R., Kra ft, A., Kozma, P., Fislage, M., Kühn, S., Ionescu, C., Speidel, S. and Had zidiakos, D., 2021. Methodology of measuring postoperative cognitive dysfu nction: a systematic review. British Journal of Anaesthesia, 126(6), pp.11 19-1127.\n\nClegg, A., Young, J., Iliffe, S., Rikkert, M. O., & Rockwood, K. (2013). Frailty in elderly people. The lancet, 381(9868), 752-762. \n\n Coley, N., Giulioli, C., Aisen, P. S., Vellas, B., & Andrieu, S. (2022). R andomised controlled trials for the prevention of cognitive decline or dem entia: A systematic review. Ageing Research Reviews, 101777.\n\nCzyż-Szype nbejl, K., Mędrzycka-Dąbrowska, W., Kwiecień-Jaguś, K., & Lewandowska, K. (2019). The occurrence of postoperative cognitive dysfunction (POCD)-syste matic review. Psychiatr Pol, 53(1), 145-160.\n\nGoldberg, T.E., Chen, C., Wang, Y., Jung, E., Swanson, A., Ing, C., Garcia, P.S., Whittington, R.A. and Moitra, V., 2020. Association of delirium with long-term cognitive dec line: a meta-analysis. JAMA neurology, 77(11), pp.1373-1381.\n\nGreene-Sch loesser D, Robbins ME, Peiffer AM, Shaw EG, Wheeler KT, Chan MD. 2012. Rad iation-induced brain injury: a review. Front Oncol. 2:73. \n\nKakuma R, du Fort GG, Arsenault L, et al. Delirium in older emergency department patie nts discharged home: effect on survival. J Am Geriatr Soc. 2003;51(4):443- 450.\n\nLee, J. S., Tong, T., Tierney, M. C., Kiss, A., & Chignell, M. (20 19). Predictive ability of a serious game to identify emergency patients w ith unrecognized delirium. Journal of the American Geriatrics Society, 67( 11), 2370-2375.\n\nLewis LM, Miller DK, Morley JE, Nork MJ, Lasater LC. Un recognized delirium in ED geriatric patients. Am J Emerg Med. 1995;13(2):1 42-145.\n\nLi, Z., Zhu, Y., Kang, Y., Qin, S., & Chai, J. (2022). Neuroinf lammation as the underlying mechanism of postoperative cognitive dysfuncti on and therapeutic strategies. Frontiers in Cellular Neuroscience, 16, 843 069.\n\nLumsden, J., Edwards, E. A., Lawrence, N. S., Coyle, D., & Munafò, M. R. (2016). Gamification of cognitive assessment and cognitive training : a systematic review of applications and efficacy. JMIR serious games, 4( 2), e5888.\n\nZhang, B., & Chignell, M. (2020, August). A framework for us ing cognitive assessment games for people living with dementia. In 2020 IE EE 8th International Conference on Serious Games and Applications for Heal th (SeGAH) (pp. 1-8). IEEE.\n\nTrack: Patient Safety Research and Initiati ves\n\nSession Chair: Victor P Cornet (Parkview Health; Indiana University , Fort Wayne) END:VEVENT END:VCALENDAR