Background. Previously, it has been demonstrated that the use of the dual-task method (performance cognitive and motor tasks simultaneously) in cognitive rehabilitation provides sustainable improvements in cognitive and motor functions. However, the effectiveness of the dual-task method in cardiac surgery patients has not been studied enough yet. Aim. To evaluate the effectiveness of the training for recovering cognitive function using a computer program of dual tasks in the early postoperative period of on-pump coronary artery bypass surgery (CABG). Material and methods. Sixty-two patients aged 64 [60; 69] years were examined before surgery and divided into two groups: with postoperative cognitive training (n=29) and without cognitive rehabilitation (n=33). The extended neuropsychological testing was performed 23 days before and 89 days after CABG to assess the psychomotor and executive functions (neurodynamic), attention and short-term memory, as well as the serum concentrations of markers of brain damage: neuron-specific enolase and S100 protein were measured. Results. The data of preoperative extended neuropsychological testing did not demonstrate between-group differences. At 810 days after CABG, 20% decrease of the cognitive indicators was detected in patients of both groups. In the group with cognitive training, the number of patients with impaired memory, attention and neurodynamics was significantly lower than in the group without training. Also, in patients who underwent cognitive rehabilitation, there was no increase in the concentrations of neuron-specific enolase and calcium-binding protein S100 compared to preoperative values, in contrast to patients without rehabilitation. Conclusion. The use of dual tasks computer program demonstrated a decrease in the severity of cognitive impairment after surgery.
Aim To study the consistency of the practice of management, selection and routing of patients at high risk of sudden cardiac death (SCD) selected for cardioverter-defibrillator implantation (CDI) with current clinical guidelines and to evaluate the quality of subsequent outpatient follow-up and treatment based on a retrospective analysis of clinical amnestic data from the Kuzbass Registry of Patients with CDI.Material and methods The study was based on the Registry of Patients with Implanted Cardioverter Defibrillator and included successive data of 28 patients hospitalized to the Kizbass Cardiological Center from 2015 through 2019. Social and clinical amnestic characteristics, indications for CVI, and concomitant drug therapy were analyzed retrospectively. Statistical analyses were performed with the Statistica 10.0 software (Statsoft, USA).Results Median age of patients was 59 (53; 66) years; 239 (83.6 %) men were included; 29 (10.1%) people were employed, CHI was performed in 182 (63.6 %) patients for prevention of SCC, and for secondary prevention in 104 (36.4 %) patients. 208 (72.7 %) patients were diagnosed with ischemic heart disease (IHD), and 145 (67.9 %) of them underwent myocardial revascularization. Noncoronarogenic diseases were found in 78 (27.3 %) patients, and most of them were diagnosed with dilated cardiomyopathy. All patients had chronic heart failure (CHF); half of them had stage IIA CHF. Median left ventricular ejection fraction was 30 (25; 36,5) % according to echocardiography using the Simpson method. Comorbidity was found in 151 (52.8 %) patients. 128 (44.8%) patients received a triple neurohormonal blockade for CHF treatment; titration to target doses was not performed in any of them. Antiarrhythmics were administered to 150 (52.4 %) patients.Conclusion According to the data from the Kuzbass Registry of CVI, the main patient cohort consisted of men of pension age with IHD and CHF. Before CVI, more than a half of them had not received an optimum drug therapy and not all of them had received target lesion revascularization. Creating and analysis of Registries of CHI patients is an effective method for identifying existing problems in patient management before CVI and for optimizing their subsequent follow-up and treatment.
Aim. To evaluate the effectiveness of dual-task computerized cognitive training (CCT) in the prevention of postoperative cognitive dysfunction in patients after on-pump coronary artery bypass grafting (CABG).Material and methods. This cohort prospective study included 68 patients (median age, 64 years [54; 69]) admitted for elective on-pump CABG. In addition to the standard preoperative examination, all patients underwent advanced neuropsychological and neurophysiological examination. Starting from 3-4 days of the postoperative period, all patients underwent dual-task CCT.Results. After 8-10 days, early postoperative cognitive dysfunction was observed in 37 (54,4%) patients from CCT group, while in patients without training in 69,3% of cases (n=79). The best results of cognitive functioning were achieved in neurodynamics and short-term memory. In addition, in patients who completed the training course, a postoperative increase in the frontooccipital gradient of theta rhythm was observed.Conclusion. Neuropsychological and neurophysiological assessment have demonstrated the limited effectiveness of a short-term dual task CCT using in the prevention of early postoperative cognitive dysfunction in patients after on-pump CABG. The dual task method can be an additional preventive intervention in the development of a personalized approach to cognitive rehabilitation therapy in cardiac surgery patients.
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