Markers of too little effort or too much alertness during neuropsychological assessment: Demonstration with perioperative changes

Abstract Objective Cognitive assessment is based on performance in different tests. However, this performance might be hindered by lack of effective effort on the one hand, and by too much stress on the other hand. Despite their known impact, there are currently no effective tools for measuring cognitive effort or stress effect during cognitive assessment. We developed real‐time electrophysiological markers for cognitive effort and for stress effect, which could be used during cognitive assessment. Methods We assessed these markers during the use of the Montreal Cognitive Assessment (MoCA) before and after cardiac surgery, which is known to involve cognitive decline in up to 30%–50% of elderly patients. Results The major findings of the study, for the largest group of patients, with preoperative MoCA in the intermediate range, were that the decline is significantly associated (1) with higher preoperative cognitive effort and (2) with higher postoperative stress effect during the test. Conclusions These findings, as well as preliminary additional ones, suggest a potential importance for monitoring cognitive effort and stress effect during assessment in general, and specifically during perioperative assessment. Significance Easy‐to‐use markers could improve the efficacy of cognitive assessment and direct treatment generally, and specifically for perioperative decline.