Strategy of Cardiovascular Surgery for Patients With Dementia as Evaluated by Mini-Mental State Examination

Abstract

Background: The strategy for cardiovascular surgery in dementia patients is controversial, so we aimed to investigate whether preoperative dementia and its severity might affect the outcomes of cardiovascular surgery by evaluating with the Mini-Mental State Examination (MMSE). Methods and Results: The study group comprised 490 patients undergoing cardiovascular surgery. Their preoperative cognitive status was evaluated using the MMSE, and analysis was performed to compare the patients with MMSE score <24 (dementia group, n=51) or MMSE score 24-30 (non-dementia group, n=439). Furthermore, the effect of the severity of dementia was analyzed with a cutoff MMSE score of 19/20. Risk factors for surgical outcomes were explored using multivariate logistic regression analysis. Hospital mortality was 11.8% in the dementia group and 2.1% in the non-dementia group (P=0.002). Regarding the postoperative morbidities, the incidence of cerebrovascular disorder (P=0.001), pneumonia (P=0.039), delirium (P=0.004), and infection (P=0.006) was more frequent in dementia group. Among the patients with MMSE <20, hospital mortality was as high as 25%, and the rate of delirium was 58%. Multivariate logistic regression analysis revealed that MMSE score <24 (P=0.003), lower serum albumin (P=0.023) and aortic surgery (P=0.036) were independent risk factors for hospital death. Conclusions: Preoperative dementia affects the outcomes of cardiovascular surgery with regard to hospital death and delirium. The surgical indication for patients with MMSE <20 might be difficult, but surgery with an appropriate strategy should be considered for patients with MMSE <24.

Dementia and Cognitive Impairment on Coronary Artery Bypass Grafting Patients in Aging Society

“…In the ROOBY trial, preoperative baseline cognitive analyses were performed, and more than 20% of patients showed MCI. Additionally in this study, less than 10% of patients were diagnosed as dementia at baseline 29) , which was similar to the reported ratio of dementia in the study by Yoshimoto and our own institution 22,28) . Silbert et al reported that some cognitive impairment was presented in ap-…”

“…In 2018, we analyzed the outcomes of cardiovascular surgery for patients with preoperative dementia and reported the optimal strategy evaluating by MMSE score 22) . The study group included 490 elderly patients, and the preoperative cognitive status was evaluated using MMSE, which had maximum score of 30 points, assessing cognitive functions in orientation, registration, attention, calculation, recall and language 18) .…”

Mild behavioral impairment is related to frailty in non-dementia older adults: a cross-sectional study

“…At enrollment, participants completed a comprehensive evaluation including but not limited to a physical examination, frailty assessment, medical record and medication review, clinical interview with questionnaires, emotional assessment and a neuropsychological assessment. Participants were excluded if they had a cognitive score consistent with dementia, de ned as a Mini Mental State Examination (MMSE) cut-off score ≥24 (49,50). Participants were also excluded if they were missing covariate data ( Figure 1 lists exclusion details).…”

Mild behavioral impairment is related to frailty in non-dementia older adults: a cross-sectional study

“…At enrollment, participants completed a comprehensive evaluation including but not limited to a physical examination, frailty assessment, medical record and medication review, clinical interview with questionnaires, emotional assessment and a neuropsychological assessment. Participants were excluded here for a cognitive diagnosis other than non-dementia, which were de ned in accordance with the MiniMental State Examination (MMSE) cut-off score ≥ 24 (34,35) (Figure 1 lists exclusion details).…”