Assessing postoperative cognitive change after cardiopulmonary bypass surgery.

Keith, Julian R.; Puente, Antonio E.; Malcolmson, Keri L.; Tartt, Shane; Coleman, Amy E.; Jr., Howard F. Marks,

doi:10.1037/0894-4105.16.3.411

Cited by 60 publications

(89 citation statements)

References 49 publications

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“…This may have been partially because of the difficulty in finding a control group that matched the CABG surgery group in important respects. Some studies have controlled mainly for the effect of age on cognitive performance, 5 whereas others have used control patients with diagnosed coronary artery disease 6 or hospital inpatients undergoing noncardiac procedures. 7 Because of the critical importance of a control for interpreting cognitive outcomes after CABG, in this review, we emphasize studies that included a control group.…”

mentioning

confidence: 99%

Neurocognitive complications after coronary artery bypass surgery

Selnes

McKhann

2005

Annals of Neurology

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Both short- and long-term cognitive changes continue to occur after coronary artery bypass grafting (CABG), but the pathophysiology of these neurobehavioral changes remains incompletely understood. The persistence of mild postoperative neurocognitive changes despite multiple improvements in the cardiopulmonary bypass procedure may be partially because of surgical populations being older and having more prevalent comorbid disease. The cause of the early postoperative changes is most likely multifactorial and may include ischemic injury from microemboli, hypoperfusion, and other factors resulting from major surgery. Several lines of evidence suggest that the late cognitive decline between 1 and 5 years after surgery may be secondary to high rates of cerebrovascular disease among candidates for CABG. A history of hypertension and other risk factors for vascular disease is known to be associated with increased risk for long-term cognitive decline in community-dwelling elderly individuals. Cerebrovascular risk factors are also associated with silent magnetic resonance imaging abnormalities in patients undergoing CABG. Thus, whereas both short- and long-term postoperative cognitive changes have been associated with CABG, only the short-term, transient changes appear to be directly related to the use of cardiopulmonary bypass.

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mentioning

confidence: 99%

Neurocognitive complications after coronary artery bypass surgery

Selnes

McKhann

2005

Annals of Neurology

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“…In addition, significant evidence has been established for detrimental neuropsychological outcomes related to cardiopulmonary surgery, with cognitive deficits found in 80% of patients during the first 2 weeks after surgery, and 10% to 57% of patients at 3 to 6 months after surgery. 2,3,4 Data from studies have led researchers to focus on the cerebral effects of inducing ventricular fibrillation and circulatory arrest during ICD surgery.…”

mentioning

confidence: 99%

A Prospective 1-Year Study of Changes in Neuropsychological Functioning After Implantable Cardioverter-Defibrillator Surgery

Hallas

Burke²,

White³

et al. 2010

Circ: Arrhythmia and Electrophysiology

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Background-The testing of the implantable cardioverter-defibrillator (ICD), through the induction of repeated episodes of ventricular fibrillation, has been associated with disturbances in cerebral activity and increased levels of cytoplasmic enzymes. However, the neuropsychological outcomes of cerebral changes and their quality-of-life implications are unknown. Methods and Results-Fifty-two ICD recipients completed standardized validated neuropsychological tests 1 to 3 days before ICD surgery and then 6 weeks, 6 months, and 12 months after surgery. They also completed psychometric tests measuring anxiety, depression, and quality of life. Between 31% and 39% of patients showed a significant neuropsychological impairment from their baseline function 6 weeks, 6 months, and 12 months after surgery. Ten percent of patients had late-onset deficits at 12 months only. Frequent areas of impairment were auditory and visual memory and attention. Neuropsychological impairment was not related to mood or quality of life at follow-up, although anxiety and depression predicted reduced quality of life. Conclusions-ICD implantation is associated with neuropsychological impairment that dissipates for the majority of recipients after 12 months. Short-term memory function and attention are particularly vulnerable to changes in oxygen during ICD testing. Although anxiety and depression are prevalent, there is little evidence for the direct impact of mood on cognition, and deficits appear not to be associated with reduced quality of life. These results provide evidence for longitudinal outcomes of ICD surgery and have implications for patient rehabilitation and adjustment. (Circ Arrhythm Electrophysiol. 2010;3:170-177.)

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“…In 12-week follow-up, the authors observed no significant differences in cognitive functions between the groups, the only exception being an improvement in verbal memory in CABG patients. The conclusions that can be drawn from the abovelisted studies [5,6,15] are that cognitive decline after CABG is transient and reversible, and in most patients cognitive functions return to their baseline levels between the third and twelfth week after surgery. Furthermore, the presence of an early postoperative cognitive decline is a risk factor for such a decline in future.…”

Section: Discussionmentioning

confidence: 99%

“…Keith et al assessed cognitive functions in 57 patients; the control group was composed of 55 people of a comparable age [5]. In patients qualified for CABG there was a lower baseline level of cognitive functions than in controls.…”

Section: Discussionmentioning

confidence: 99%

“…This is probably due to the fact that the implementation of precise test batteries is time-consuming and their interpretation requires the participation of a psychologist or a psychiatrist. The available data regarding the incidence and severity of post-operative changes in cognitive functions as well as the factors that negatively affect cognitive functions differ significantly [2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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