CODEX is assessing cognitive performance with the CBB. CBB assesses four cognitive domains (psychomotor function, attention, learning and working memory). It has nearly infinite alternate forms (based on 52 deck playing cards) and a large database of sex-matched and age-matched test results against which to normalise, and it is relatively fast to administer (20 min). Importantly, it has been validated against traditional neuropsychological tests in a variety of clinical conditions and brain disorders across time.44–46 A score of <80 on any of the four domains corresponds to major P-NCD (RCI >1.96). CBB allows assessment of cognitive status at multiple time points (preoperative, postoperative and three times post discharge) to identify cognitive trajectories without the need to adjust for learning effects up to 1 year after surgery (figure 1). Additionally, CBB allows cognition to be assessed remotely reducing loss to follow-up and increasing accessibility. To our knowledge, this will be the first large study to screen and detect cognitive decline or perioperative NCDs using the CBB tool.

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