Liu et al 1 deserve credit for studying young and middle-aged adults undergoing laparoscopic surgery, a group overlooked in perioperative neurocognitive research.Remimazolam was associated with less postoperative memory decline than propofol on postoperative day 1, 36.4% versus 53.2%, and day 3, 23.6% versus 37.8%, while the month-1 cognitive endpoint was similar, 6.4% versus 8.1%.However, there are two issues warrant discussion.One concern is the mismatch between the eligibility criteria and the baseline table .The Methods exclude patients with preoperative MoCA 31 is normal and <28 indicates severe impairment, whereas page 5 states that an education-adjusted TICS-m score 31 is the optimal cutoff for cognitive impairment.That leaves the 28-31 interval unresolved and creates internal inconsistency.Truong et al 4 reported good TICS-m reliability in 432 older adults, with a Person Separation Index of 0.86, but this supports careful within-instrument interpretation, not direct interchangeability with MoCA across time.A 2024 perioperative guidance likewise emphasizes baseline neurocognitive assessment when postoperative neurocognitive outcomes are inferred. 5eporting both raw and adjusted baseline MoCA distributions, the number of patients below 26 before and after education correction, and a prespecified TICS-m classification scheme would materially strengthen this otherwise valuable study.
Zhou et al. (Wed,) studied this question.