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Anesthesiology CME Program  |   January 2008
Instructions for Obtaining Journal CME Credit
Article Information
Anesthesiology CME Program
Anesthesiology CME Program   |   January 2008
Instructions for Obtaining Journal CME Credit
Anesthesiology 1 2008, Vol.108, 179-180. doi:10.1097/01.anes.0000303096.50193.08
Anesthesiology 1 2008, Vol.108, 179-180. doi:10.1097/01.anes.0000303096.50193.08
Anesthesiology’s journal-based CME program is open to all readers. Members of the American Society of Anesthesiologists participate at a preferred rate, but you need not be an ASA member or a journal subscriber to take part in this CME activity. Please complete the following steps:
  1. Read the article by Monk et al.  entitled “Predictors of cognitive dysfunction after major noncardiac surgery” on page 18 and the accompanying editorial by Maze et al  . entitled “Taking the lead in research into postoperative cognitive dysfunction” on page 1 of this issue.

  2. Review the questions and other required information for CME program completion (published in both the print and online journal).

  3. When ready, go to the CME Web site: . Submit your answers, form of payment, and other required information by December 31 of the year following the year of publication.

The American Society of Anesthesiologists is approved by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education programs for physicians.
The American Society of Anesthesiologists designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit  ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Purpose:  The focus of the journal-based CME program, and the articles chosen for the program, is to educate readers on current developments in the science and clinical practice of the specialty of Anesthesiology.
Target Audience:  Physicians and other medical professionals whose medical specialty is the practice of anesthesia.
Learning Objectives:  After reading this article, participants should have a better understanding of postoperative cognitive change in all age groups.
Disclosure Information:
Authors  – Terri G. Monk, M.D., M.S., B. Craig Weldon, M.D., Cyndi W. Garvan, Ph.D., Duane E. Dede, Ph.D., Maria T. van der Aa, M.S., Kenneth M. Heilman, M.D., and Joachim S. Gravenstein, M.D.
Grants or research support:  Supported by grant No. K01-AG19214 from the National Institute on Aging, Bethesda, Maryland; the Anesthesia Patient Safety Foundation, Indianapolis, Indiana; and the I. Heermann Anesthesia Foundation, Gainesville, Florida.
Consultantships or honoraria:  None
Authors  – Mervyn Maze, M.B., Ch.B., F.R.C.P., F.R.C.A., F.Med.Sci., Mario Cibelli, M.D., and Hilary P. Grocott, M.D., F.R.C.P.C., F.A.S.E.
Grants or research support:  None
Consultantships or honoraria:  Dr. Maze is a paid consultant for Air Products, Allentown, Pennsylvania, which is involved, together with Air Liquide Sante, in the commercial exploitation of xenon for postoperative cognitive dysfunction after cardiac surgery. If xenon is marketed and sold for this application, Dr. Maze is eligible to receive royalties at a rate of approximately 1% of sales.
Question Writer  – Leslie C. Jameson, M.D.
Dr. Jameson has no grants, research support, or consultant positions, nor does she receive any honoraria from outside sources, which may create conflicts of interest concerning this CME program.
Article Questions
Based on the article by Monk et al  . entitled “Predictors of cognitive dysfunction after major noncardiac surgery” and its accompanying editorial by Maze et al  . entitled “Taking the lead in research into postoperative cognitive dysfunction” in the January issue of Anesthesiology, choose the one correct answer for each question:
1. Which of the following statements about the assessment of postoperative cognitive function is most  likely true?
A. Mini-Mental State Examination score higher than 23 suggests significant cognitive impairment.
B. Repeated neuropsychological testing does not change test performance.
C. Memory cognitive function can be assessed separately from attention cognitive function.
D. Changes in ability to perform basic daily activities are not considered an important part of cognitive assessment.
2. To evaluate the cognitive changes that occur in patients undergoing noncardiac surgery, the patients were grouped as young (18–39 yr), middle-aged (40–59 yr), and elderly (60 yr or older). Which statement comparing baseline characteristics of the groups is most  likely true?
A. The elderly group had a lower educational score than the middle-aged group.
B. Patients in the elderly group were less likely to be depressed than patients in the other groups.
C. The young patient group had lower anxiety scores than the elderly patient group.
D. American Society of Anesthesiologists physical status classification was the same in the middle-aged and elderly patient groups.
3. Which statement about the prevalence of postoperative cognitive impairment is most  likely true?
A. Three months after surgery, more than 12% of patients in the elderly group still had significant cognitive dysfunction.
B. At 3 months after surgery, patients in the middle-aged group had a significantly greater rate of impairment than the age-matched control group.
C. More than 50% of the patients in the elderly group had cognitive impairment 7 days after surgery.
D. In the young patient group, 10% of patients had cognitive impairment 7 days after surgery.
4. Risk factors for cognitive impairment 3 months after surgery include all of the following except 
A. Delirium in the first 24 h after surgery
B. Age
C. Years of education
D. History of cerebral vascular accident without residual symptoms
5. Which of the following statements about patient mortality and cognitive function is most  likely true?
A. Patients with cognitive dysfunction 7 days after surgery have a significant increase in 1-yr mortality compared with similar patients without cognitive dysfunction.
B. Population-based studies do not associate increased risk of early mortality with cognitive decline.
C. Clinical depression when associated with cognitive decline decreases the risk of mortality in the elderly.
D. Patients with cognitive dysfunction at hospital discharge and  3 months after surgery have a 2.5-fold increase in 1-yr mortality compared with patients without cognitive dysfunction.
6. Which of the following statements about the potential causes of long-term postoperative cognitive impairment is most  likely true?
A. Increased cognitive reserve does not ameliorate the severity of cognitive decline.
B. Increased years of formal education reduces the number of neural pathways available to recover from neurologic damage.
C. Inflammation in specific areas of the brain could impair learning or memory.
D. In patients with postoperative cognitive impairment, the same anatomic brain regions are always affected.