Defining neuropsychological dysfunction after coronary artery bypass grafting

Mahanna, Elizabeth; Blumenthal, James A.; White, William D.; Croughwell, Narda D.; Clancy, Carolina P.; Smith, L. R.; Newman, Mark F.

doi:10.1016/0003-4975(95)01095-5

Cited by 244 publications

(153 citation statements)

References 24 publications

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“…However, the measured degree of cognitive decline in this and other studies is influenced not only by intervention but also by the sensitivity and specificity of the tests used. 20 …”

Section: Cognitive Function Testingmentioning

confidence: 99%

“…The spectrum of central nervous system morbidities after CPB includes cognitive dysfunction, encephalopathy, stroke, and brain death. 20,42 Cognitive dysfunction is the most prevalent and subtle manifestation of central nervous system morbidity, occurring in 30% to 75% of patients after CPB and in up to 40% of patients 2 months after discharge. [43][44][45][46] The cause of the cognitive decline is believed to be related to multifocal ischemic and/or hypoxic insults to the brain, leading to neuronal loss.…”

Section: Fitch Et Al C5 Inhibition During Cpbmentioning

confidence: 99%

See 1 more Smart Citation

Pharmacology and Biological Efficacy of a Recombinant, Humanized, Single-Chain Antibody C5 Complement Inhibitor in Patients Undergoing Coronary Artery Bypass Graft Surgery With Cardiopulmonary Bypass

et al. 1999

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Background-Cardiopulmonary bypass (CPB) induces a systemic inflammatory response that causes substantial clinical morbidity. Activation of complement during CPB contributes significantly to this inflammatory process. We examined the capability of a novel therapeutic complement inhibitor to prevent pathological complement activation and tissue injury in patients undergoing CPB. Methods and Results-A humanized, recombinant, single-chain antibody specific for human C5, h5G1.1-scFv, was intravenously administered in 1 of 4 doses ranging from 0.2 to 2.0 mg/kg before CPB. h5G1.1-scFv was found to be safe and well tolerated. Pharmacokinetic analysis revealed a sustained half-life from 7.0 to 14.5 hours. Pharmacodynamic analysis demonstrated significant dose-dependent inhibition of complement hemolytic activity for up to 14 hours at 2 mg/kg. The generation of proinflammatory complement byproducts (sC5b-9) was effectively inhibited in a dose-dependent fashion. Leukocyte activation, as measured by surface expression of CD11b, was reduced (PϽ0.05) in patients who received 1 and 2 mg/kg. There was a 40% reduction in myocardial injury (creatine kinase-MB release, Pϭ0.05) in patients who received 2 mg/kg. Sequential Mini-Mental State Examinations (MMSE) demonstrated an 80% reduction in new cognitive deficits (PϽ0.05) in patients treated with 2 mg/kg. Finally, there was a 1-U reduction in postoperative blood loss (PϽ0.05) in patients who received 1 or 2 mg/kg. Conclusions-A single-chain antibody specific for human C5 is a safe and effective inhibitor of pathological complement activation in patients undergoing CPB. In addition to significantly reducing sC5b-9 formation and leukocyte CD11b expression, C5 inhibition significantly attenuates postoperative myocardial injury, cognitive deficits, and blood loss. These data suggest that C5 inhibition may represent a novel therapeutic strategy for preventing complement-mediated inflammation and tissue injury. (Circulation. 1999;100:2499-2506.)

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“…However, the measured degree of cognitive decline in this and other studies is influenced not only by intervention but also by the sensitivity and specificity of the tests used. 20 …”

Section: Cognitive Function Testingmentioning

confidence: 99%

Section: Fitch Et Al C5 Inhibition During Cpbmentioning

confidence: 99%

Pharmacology and Biological Efficacy of a Recombinant, Humanized, Single-Chain Antibody C5 Complement Inhibitor in Patients Undergoing Coronary Artery Bypass Graft Surgery With Cardiopulmonary Bypass

et al. 1999

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“…Ancak küçük değişikliklerin anlamlı olabileceğini savunanlar da çoktur. [24] Çalışmamızda NAC uygulanmayan kontrol grubu değerlendirildiğinde, verbal akıcılık, renk-kelime, iz sürme testlerinde ameliyat sonrası performanslarda azalma görüldü. Görsel bellek testi ve sayı dizisi testlerinde ise ameliyat sonrası performans artışı görüldü.…”

Section: Discussionunclassified

Effects of N-acetylcysteine on neurocognitive functions after coronary artery bypass graft surgery

Unlu¹

2013

Turk Gogus Kalp Dama

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“…This approach, however, does not take into account the age-matched controls and, thus, the variability that could occur in healthy individuals over time. 76 A more recent approach relies upon statistically driven methods to assess 'real change' through formulae such as the reliable change index (RCI). 77, 78 The RCI can be mathematically calculated using published methodology.…”

Section: Postoperative Cognitive Dysfunctionmentioning

confidence: 99%

Understanding terminology of delirium and long-term cognitive impairment in critically ill patients

Morandi

Pandharipande

Jackson

et al. 2012

Best Practice & Research Clinical Anaesthesiology

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Keywords: delirium long-term cognitive impairment terminology critical careDelirium, an acute brain dysfunction, frequently affects intensive care unit (ICU) patients during the course of a critical illness. Besides the acute morbidities, ICU survivors often experience longterm sequelae in the form of cognitive impairment (LTCI-CI). Though delirium and LTCI-CI are associated with adverse outcomes, little is known on the terminology used to define these acute and chronic co-morbidities. The use of a correct terminology is a key factor to spread the knowledge on clinical conditions. Therefore, we first review the epidemiology, definition of delirium and its related terminology. Second, we report on the epidemiology of LTCI-CI and compare its definition to other forms of cognitive impairments. In particular, we define mild cognitive impairment, dementia and finally postoperative cognitive dysfunction. Future research is needed to interpret the trajectories of LTCI-CI, to differentiate it from neurodegenerative diseases and to provide a formal disease classification.

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Defining neuropsychological dysfunction after coronary artery bypass grafting

Cited by 244 publications

References 24 publications

Pharmacology and Biological Efficacy of a Recombinant, Humanized, Single-Chain Antibody C5 Complement Inhibitor in Patients Undergoing Coronary Artery Bypass Graft Surgery With Cardiopulmonary Bypass

Pharmacology and Biological Efficacy of a Recombinant, Humanized, Single-Chain Antibody C5 Complement Inhibitor in Patients Undergoing Coronary Artery Bypass Graft Surgery With Cardiopulmonary Bypass

Effects of N-acetylcysteine on neurocognitive functions after coronary artery bypass graft surgery

Understanding terminology of delirium and long-term cognitive impairment in critically ill patients

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