Table 1.
Recommended neuropsychological measures for the detection and characterization of POCD
| Core Domain |
Component Cognitive Process |
Measure | Description | Brain regions/circuits involved in task** |
|---|---|---|---|---|
| Global | Multiple | Montreal Cognitive Assessment (MoCA) | The MoCA is a brief cognitive screening measure tapping multiple cognitive domains, including brief assessment of memory and orientation. The screening measure is freely available (www.mocatest.org) and has the advantage of multiple alternate forms, which can help in preventing over-estimation of POCD recovery secondary to simple re-administration practice effects. Administration Time: Variable, with ~15 minute average. (126,127) |
Multiple tasks, n/a. |
| Executive Function | Simple Attention | Digit Span Forward Subtest from Wechsler Adult Intelligence Scale − 3rd Revision (WAIS- III) | The Digit Span Forward subtest from the WAIS-III is a simple auditory-verbal attention task, in which a participant is asked to attend to and immediately repeat a series of serially presented digits that increase in total span as the test progresses. Administration Time: Variable, with ~5–10 minute average. |
Right dorsolateral prefrontal cortex (128) |
| Complex Attention (Working Memory) | Digit Span - Backward Subtest from Wechsler Adult Intelligence Scale − 3rd Revision (WAIS- III) or Letter- Number Sequencing Subtest from WAIS-III | The Digit Span Backward (or Letter-Number Sequencing) subtest from the WAIS-III engages both simple attention and working memory skills. Participants are instructed to attend to a series of verbally presented digits of increasing total length, but rather than respond verbatim participants are instructed to repeat the presented digits in reverse order. In the alternate Letter-Number Sequencing subtest from the WAIS-III participants are presented with randomized series of digits and letters of the alphabet of increasing length and asked to respond to a particular series with all digits in ascending order and all letters in alphabetical order.(128,129) Administration Time: Variable, with ~5–10 minute average. |
right dorsolateral prefrontal cortex (128) | |
| Response Inhibition | Stroop Color Word Test | A time limited test of the ability to inhibit a pre-potent response, known to be sensitive to medial prefrontal lobe dysfunction. The Stroop Color Word Test requires participants to read a series of color words (red, green, blue), then name the color ink of a series of X characters, after which an inhibition trial is given in which the participant is asked to name the color ink of a series of color words that are in opposition to the ink color (e.g., the word blue printed in red ink). The natural tendency of participants is to say the word as printed rather than the ink color; hence the sensitivity of the measure to response inhibition skills. Administration Time: 3–4 minutes. |
Anterior cingulate cortex (ACC), right inferior frontal gyrus, and cerebellum. (130) | |
| Mental Flexibility | Trail Making A & B Test * | The timed Trail Making A subtest requires participants to connect a series of numbered circles distributed on a piece of paper in ascending numerical order, while the Trail Making B subtest has both letters of the alphabet and numbers in circles that then must be connected in alternating ascending order (e.g., 1-A-2-B-3-C…). Trail Making A & B tests should be administered in immediate succession, as the Trail Making A subtest is necessary for familiarization of general subtest B task requirements. Independent administration of Trail Making B test only may result in over-estimation of POCD severity.(131,132) Administration Time: Variable w/ 5 minute timed maximum for each subtest. |
Medial Temporal Lobe (132) | |
| Verbal Fluency | Controlled Oral Word Association Test (COWA) from the Multilingual Aphasia Examination (MAE) * | A lexical verbal fluency task known to be dependent upon pre-Broca area function in the language dominant brain hemisphere. This test also requires retention of task rules for proper performance. Participants say as many words as they can retrieve that start with a particular consonant with 1-minute given for three different consonants (e.g., C, F, L). Participants are asked to not use proper nouns or the same word with different endings (e.g., eat, eating). Administration Time: 3 minutes. |
Posterior part of the left inferior prefrontal cortex (LIPC); category fluency task activates anterior left inferior prefrontal cortex and right inferior prefrontal cortex. (133,134) | |
| Learning & Memory | Auditory- Verbal Learning & Memory | Hopkins Verbal Learning Test, Revised * | An auditory-verbal, list-learning and memory task that involves the presentation of 12 various categorically related item words (e.g., gemstones, furniture, etc.) that are then immediately recalled by the participant. Participants are given the opportunity to learn the list of words over a series of three repeated presentations, then after a 25- minute delay participants are assessed for delayed recall and recognition memory for the primary word list items. Scored items include total recall, delayed recall, percent retention (after delay) and recognition discrimination index. Administration Time: 35 minutes timed (includes 25-minute delay) |
Left ventrolateral prefrontal cortex (135) |
| Visual Learning & Memory | Brief Visuospatial Learning Test, Revised * | A visuospatial learning and memory test analog to the HVLT-R. Six simple line drawings are presented in a 2 × 3 array on a single piece of paper and participants are allowed a brief period to study the figures, after which they are asked to reproduce as many figures in their proper locations as they can on a blank sheet of paper. Three learning trials of the six line drawings are conducted. There is a 25-minute delay, after which participants are asked to recall as many figures in their locations as possible. Delayed recognition for the same line drawings is also conducted. Scored items are the same as the HVLT-R (e.g., total recall, delayed recall, etc.).(136) Administration Time: 45 minutes timed (includes 25-minute delay) |
||
| Visuospatial Functioning | Visuomotor Integration | Digit Symbol Coding Test from the Wechsler Adult Intelligence Scale – 3rd Revision (WAIS- III) | The Digit Symbol Coding Test requires participants to use a symbol/number key at the top of a printed page as a guide to determine the appropriate missing symbols for a large array of unmatched numbers below the test key. The task is timed and the scored response is the total number of correct symbol/number pairs completed by the participant within 120-seconds. Administration Time: 5 minutes. |
Corpus callosum, internal capsule (137); anterior cingulate gyrus, left prefrontal gyrus and inferior parietal lobe (138) |
| Complex Visuospatial Perception | Hooper Visual Organizational Test | HVOT performance is known to be dependent upon bilateral parietal and temporal-occipital cortex functioning and involves participants’ mental integration and naming of common objects presented in a spatially scattered puzzle piece-like format. Proper execution of the task requires participants to mentally rotate and connect partial stimuli pieces into a whole to form a perceptual gestalt. Administration Time: Variable, with ~10–12 minute average. |
Superior parietal lobules, ventral temporal- occipital cortex, and posterior visual association areas, frontal eye fields, left dorsolateral prefrontal cortex (139) | |
| Psychomotor Function | Manual Dexterity & Motor Speed | Lafayette Grooved Pegboard Test | A manipulative dexterity and motor speed test that involves the insertion of small milled key-like pins into randomly rotated matching holes arranged in a 5 × 5 array. Each hand is evaluated separately with a score reflecting the total time to complete insertion of all 25 pegs for each hand. Administration Time: Variable, with ~5 minute average. |
Nigrostriatal dopamine function (140) |
*
Note: Recommended measures with readily available alternate, equivalent forms are denoted with a “*” symbol.