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. 2025 Jul 17;6(8):e70302.
doi: 10.1002/mco2.70302. eCollection 2025 Aug.

Association Between Preoperative Cognitive Performance and Postoperative Delirium in Older Patients: Results From a Multicenter, Prospective Cohort Study, and a Mendelian Randomization Study

Rao Sun  1 , Shiyong Li  1 , Changming Yang  2   3 , Guiming Huang  4 , Chunrong Tang  5 , Wei Li  6 , Zhongyuan Xia  7 , Mingzhang Zuo  8 , Ning Yang  8 , Huiyu Luo  9 , Kun Zhang  10 , Huajun Li  11 , Qingfeng Zeng  12 , Chun Chen  13 , Lan Wang  14 , Rui Xia  15 , Chuanbin Dong  16   17 , Junmin He  18 , Qiaoqiao Xu  1 , Xinhua Li  1 , Biyun Zhou  1 , Shangkun Liu  1 , Fang Luo  1 , Zhiqiang Zhou  1 , Ailin Luo  1
Affiliations

Association Between Preoperative Cognitive Performance and Postoperative Delirium in Older Patients: Results From a Multicenter, Prospective Cohort Study, and a Mendelian Randomization Study

Rao Sun et al. MedComm (2020). .

Abstract

This study evaluated the association between preoperative cognitive performance and postoperative delirium (POD) using a multicenter prospective cohort, and explored potential causality using Mendelian randomization (MR) analysis. We analyzed data from 2257 patients aged ≥ 75 years undergoing elective noncardiac and noncranial surgeries across 16 Chinese medical centers. Preoperative cognitive assessment using Mini-Cog revealed 28.4% of patients had cognitive impairment (score ≤ 2). POD occurred in 9.7% of patients, with higher incidence among those with cognitive impairment. Logistic regression demonstrated that cognitive impairment was significantly associated with increased POD risk (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.55-2.74; p < 0.001). This association persisted after adjustment for demographic, preoperative, and intraoperative factors, and was confirmed through propensity score matching and inverse probability treatment weighting analyses. A nearly linear inverse association was observed between Mini-Cog scores and POD incidence. Complementary MR analysis using 139 SNPs from European ancestry data suggested that higher cognitive performance might be associated with decreased delirium risk (inverse-variance weighted OR, 0.74; 95% CI, 0.59-0.93; p = 0.009). Although these results point to a potential link between preoperative cognition and POD, interpretation of causality should be approached with caution, particularly given differences in populations and genetic datasets.

Keywords: Mendelian randomization; Mini‐Cog test; cognitive impairment; postoperative delirium; prospective cohort study.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart for patient selection.
FIGURE 2
FIGURE 2
Restricted cubic spline curves depicting the relationship between Mini‐Cog scores and postoperative delirium. (A) Univariable logistic regression model. (B) Multivariable logistic regression model adjusted for patients' demographics, comorbidities, American Society of Anesthesiologists physical status, lifestyle factors, New York Heart Association functional class, functional capacity as well as intraoperative data, such as type of surgery, type and duration of anesthesia, benzodiazepines administration, occurrence of prolonged intraoperative hypotension (> 5 min), blood loss, and allogeneic blood transfusion. CI, confidence interval.
FIGURE 3
FIGURE 3
Distribution of propensity scores among patients with and without cognitive impairment. IPTW, inverse probability treatment weighting; PSM, propensity score matching.
FIGURE 4
FIGURE 4
Forest plot of MR analysis for the causal effect of cognitive performance on delirium risk. CI, confidence interval; MR, Mendelian randomization; MR‐PRESSO, Mendelian randomization‐pleiotropy residual sum and outlier; OR, odds ratio; SNPs, nucleotide polymorphisms.
See this image and copyright information in PMC

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