Using the ascertain dementia eight-item questionnaire to identify at-risk older surgical patients

Ellene Yan; Yasmin Alhamdah; Nina Butris; Paras Kapoor; David He; Leif Erik Lovblom; Maria Carmela Tartaglia; David F Tang-Wai; Aparna Saripella; Sazzadul Islam; Jean Wong; Frances Chung

doi:10.1016/j.jclinane.2026.112256

Using the ascertain dementia eight-item questionnaire to identify at-risk older surgical patients

J Clin Anesth. 2026 Jun 4:113:112256. doi: 10.1016/j.jclinane.2026.112256. Online ahead of print.

Authors

Affiliations

¹ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Krembil Brain Institute, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
² Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
³ Biostatistics Department, University Health Network, Toronto, ON, Canada.
⁴ Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Krembil Brain Institute, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Krembil Brain Institute, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁶ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
⁷ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada.
⁸ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Krembil Brain Institute, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada. Electronic address: frances.chung@uhn.ca.

PMID: 42242113
DOI: 10.1016/j.jclinane.2026.112256

Abstract

Background: Preoperative identification of cognitive impairment (CI) can enhance risk stratification. To date, few studies have comprehensively examined the preoperative utility of the Ascertain Dementia Eight-item Questionnaire (AD8), an ultra-rapid cognitive screening tool, in identifying patients at risk of adverse outcomes. This report investigated the association between probable preoperative CI using the AD8, its individual items, and domain-specific impairments (memory and executive function) and 30- and 90-day adverse outcomes.

Methods: This post hoc analysis included two cohort studies involving non-cardiac surgical patients ≥ 65 years old. Preoperative CI was screened using the self-reported AD8 (cut-off ≥ 2), which assessed judgement, apathy, repetition, learning, orientation, finances, remembering, and daily thinking/memory.

Results: Of 689 participants, CI was associated with delirium (adjusted odds ratio [aOR]: 3.64, 95% CI: 1.31, 9.49, P-value = 0.009), 90-day complications (aOR: 2.26, 95% CI: 1.14, 4.28, P-value = 0.015), and 90-day composite adverse outcomes (aOR: 2.03, 95% CI: 1.03, 3.81, P-value = 0.033). Importantly, the AD8 item on repetition was associated with delirium (aOR: 6.11, 95% CI: 2.05, 16.48, P-value = 0.004), 30-day complications (aOR: 2.53, 95% CI: 1.43, 4.45, P-value = 0.004), and 30-day composite adverse outcomes (aOR: 2.52, 95% CI: 1.44, 4.46, P-value = 0.004). Also, memory-related problems showed higher odds of delirium (aOR: 5.11, 95% CI: 1.90, 13.32, P-value = 0.007), 30-day all-cause complications (aOR: 1.77, 95% CI: 1.11, 2.79, P-value = 0.044), and 30-day composite adverse outcomes (aOR: 2.02, 95% CI: 1.30, 3.14, P-value = 0.008).

Conclusions: A positive AD8 screen identified older surgical patients at risk of delirium and 90-day complications. Of all AD8 items, repetition was associated with the greatest number of adverse outcomes within 30 days postoperatively, highlighting its potential preoperative utility.

Keywords: Adverse outcomes; Ascertain dementia eight-item questionnaire. Elderly patients; Cognitive impairment; Geriatrics; Older patients; Surgery.