To evaluate whether, among ≥65 years old people, a ≥2 point decline in the Montreal Cognitive Assessment (MoCA) 1 year after noncardiac surgery is associated with patient-important outcomes.

NeuroVISION was an international prospective cohort study of 1114 patients, ≥65 years old, undergoing elective noncardiac surgery. In NeuroVISION, 30.3% of patients had a ≥2 point decrease in MoCA from baseline to 1 year after surgery. A ≥2 point MoCA decrease has been associated with cognitive decline based on formal neuropsychological testing. However, there is paucity of data on its association with patient-important outcomes.

NeuroVISION participants had MoCA, Lawton iADL, and EQ-5D questionnaires administered at baseline and 1 year after surgery. The iADL score was defined as the number of instrumental activities in which patients were independent (range 0-8). At 1 year participants also reported whether they had had any fall in the previous year. We performed multivariable regression analyses adjusting for age, sex, and baseline scores. 

At baseline, the median iADL score of NeuroVISION participants was 8 (interquartile range 7-8). At 1-year, patients with ≥2 point MoCA decline reported a greater decline in iADL (adjusted beta coefficient -0.20, 95% CI -0.36 to -0.05; p=0.010) and in EQ-5D VAS scores (adjusted beta-coefficient -2.90, 95% CI -5.08 to -0.73; p=0.009) than patients without. 22.2% of the patents with versus 12.1% of patients without a ≥2 point MoCA decline lost independence in ≥1 iADL (adjusted odds ratio 1.93, 95% CI 1.35-2.76, p<0.001). At 1 year, patients with a ≥2 point MoCA decline reported more frequently ≥1 fall (14.9% versus 10.2%), and a higher number of falls (adjusted incident risk ratio 1.76, 95% CI 1.28 – 2.40).

In the large NeuroVISION cohort, a ≥2 point MoCA decline 1 year after noncardiac surgery was not only frequent but also associated with functional decline.