{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:01:37Z","timestamp":1780736497574,"version":"3.54.1"},"reference-count":76,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Cognitive impairment and pain catastrophizing are both associated with worse surgical outcomes. The aim of this study was to define the prevalence of cognitive impairment in patients with adult spinal deformity (ASD) and the relationships between cognitive impairment, pain catastrophizing, patient-reported outcome measures (PROMs), and frailty in the preoperative setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This cross-sectional study included patients undergoing evaluation for ASD correction at a single tertiary care center from January 2017 to October 2024. Patients were administered the Montreal Cognitive Assessment (MoCA), Pain Catastrophizing Scale (PCS), Scoliosis Research Society 22-item revised (SRS-22r) questionnaire, the Oswestry Disability Index (ODI), and the Edmonton Frail Scale (EFS). Median survey responses were compared between patients with any cognitive impairment (MoCA score &lt; 26) and no cognitive impairment (MoCA score \u2265 26) using the Mann-Whitney U-test. Associations between survey responses were tested using Spearman\u2019s rank correlation analysis. Multivariate logistic regression analysis was performed to identify predictors of severe pain catastrophizing (PCS score \u2265 30).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 210 patients (61.4% female, median age 66.5 years) were included in the study. Of these, 123 (58.6%) had normal cognition and 87 (41.4%) had mild or moderate cognitive impairment. Patients with cognitive impairment had greater median PCS scores compared with patients with normal cognition (total PCS score 25.0 vs 19.0, p = 0.01). Lower MoCA scores were significantly correlated with higher PCS (\u03c1 = \u22120.23, p = 0.0007) and EFS (\u03c1 = \u22120.21, p = 0.0074) scores, but not ODI and total SRS-22r scores. In the multivariate logistic regression analysis, lower MoCA and SRS-22r scores were associated with greater odds of having severe pain catastrophizing (MoCA: OR 0.82 [95% CI 0.68\u20130.98], p = 0.03; SRS-22r: OR 0.05 [95% CI 0.01\u20130.19], p &lt; 0.0001), while ODI score, EFS score, age, and sex were not associated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>There was a high prevalence (41.4%) of cognitive impairment in patients with ASD. In both the correlation and multivariate logistic regression analyses, cognitive impairment was associated with pain catastrophizing and thus might contribute to pain perception and frailty in a way that is not consistently captured by traditional PROMs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.3.focus2538","type":"journal-article","created":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T05:55:23Z","timestamp":1748757323000},"page":"E2","source":"Crossref","is-referenced-by-count":1,"title":["Pain catastrophizing and frailty in adult spinal deformity patients with cognitive impairment"],"prefix":"10.3171","volume":"58","author":[{"given":"Alexa","family":"Semonche","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin K.","family":"Scheer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin","family":"Lui","sequence":"additional","affiliation":[{"name":"Department of Osteopathic Medicine, Touro University, Vallejo, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F.","family":"Burke","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chloe","family":"Jedwood","sequence":"additional","affiliation":[{"name":"College of Letters and Science, University of California, Berkeley, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaina J.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Catalan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, Los Angeles;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany","family":"Belfield","sequence":"additional","affiliation":[{"name":"College of Letters and Science, University of California, Berkeley, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Thapar","sequence":"additional","affiliation":[{"name":"College of Letters and Science, University of California, Berkeley, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael M.","family":"Safaee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Southern California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darryl","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa","family":"Fury","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Wozny","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony L.","family":"Mikula","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mazur-Hart","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alekos A.","family":"Theologis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron J.","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California;"},{"name":"Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York; 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