Date of Award

3-2017

Document Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Graduate Department of Clinical Psychology

First Advisor

Kathleen Gathercoal, PhD

Second Advisor

Glena Andrews, PhD

Third Advisor

Freeman Chakara, PsyD

Abstract

Cognitive dysfunction post-surgery has a significant impact on patients’ quality of life during recovery and afterward. Several studies have been completed on post-operative cognitive dysfunction (POCD), but since studies are varied in their methodologies and designs a metaanalysis is helpful to synthesize the current available research. The present study took a metaanalysis approach to examine neuropsychological tests most sensitive to POCD in adult surgery patients, and determine implications this would have for developing a battery of tests to evaluate for POCD pre and post-surgery. Although some assessment batteries have been proposed for certain populations (e.g., cardiac patients), little research has been completed on what tests are most sensitive within a general population of patients. Journal articles on POCD were located through medical and psychological research databases. Of the 109 articles that could potentially be included, 24 met inclusion criteria. 192 effect sizes were calculated, with 2,188 participants across all studies. Articles were coded for assessment measures and various factors for studies that included both POCD and non-POCD patients, and effect sizes were determined for each of the neuropsychological tests included in each article using the software Comprehensive Meta- Analysis Professional Version 3. POCD effect sizes were significantly higher in Chinese studies, as compared with studies from other research centers and so Chinese studies were excluded from the final analysis. The final analysis found older adults have more severe cognitive decline due to POCD symptoms, that the most prominent time for symptoms is 7-14 days post-surgery, and that patients have the same pattern of POCD deficits after cardiac surgery as after non-cardiac surgery. The Mini-Mental State Examination (MMSE) was found to be very sensitive to identifying POCD, and tests measuring delayed recall, language, and processing speed were found to be moderately effective in detecting POCD. Implications of these results for postsurgery care of geriatric patients as well as the implications for neuropsychological testing for POCD symptoms are discussed.

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