Does Preoperative Mild Cognitive Impairment Predict Postoperative Cognitive Dysfunction after On-Pump Coronary Bypass Surgery?

Трубникова, О. А.; Mamontova, Anastasia S; Сырова, И. Д.; Малева, О. В.; Barbarash, O. L.

doi:10.3233/jad-132540

Cited by 17 publications

(24 citation statements)

References 19 publications

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“…Yet, studies suggest that patients with MCI and cognitively normal patients have similar risks and outcomes of CVD treatments including thrombolysis for stroke [45,46] and coronary revascularization. [47] The interviews identified additional potential reasons why physicians might recommend fewer guideline-concordant treatments to patients with pre-existing MCI than to cognitively normal patients. Physicians might conflate MCI with dementia or overestimate the risk of dementia, consistent with research showing that people tend to overestimate the likelihood of rare events and underestimate the likelihood of common events.…”

Section: Plos Onementioning

confidence: 99%

Physician decision-making and recommendations for stroke and myocardial infarction treatments in older adults with mild cognitive impairment

et al. 2020

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Evidence suggests that older adults with mild cognitive impairment (MCI) might not receive evidence-based treatments. We explored the impact of patient MCI on physician decisionmaking and recommendations for acute ischemic stroke (AIS) and acute myocardial infarction (AMI) in a pilot concurrent mixed-methods study of physicians recruited from one academic center. The mailed survey included a clinical vignette of AIS or AMI where the patient cognitive status was randomized (normal cognition, MCI, or early-stage dementia). The primary outcome was a composite summary measure of the proportion of guideline-concordant treatments recommended. Linear regression compared the primary outcome across patient cognition groups adjusting for physician characteristics. Semi-structured interviews done with 18 physicians (4 cardiologists, 9 neurologists, 5 internists) using a standard guide. Survey response rate was 72% (82/114) (49/61 neurologists; 33/53 cardiologists). As patient cognition worsened, neurologists recommended less guideline-concordant treatments after AIS (P trend <0.001 across patient cognition groups). Cardiologists did not after AMI (P trend = 0.11) in adjusted analyses. Neurologists' recommendation of guideline-concordant treatments after AIS was non-significantly lower in patients with MCI (composite measure, 0.13 points lower; P = 0.14) and significantly lower in patients with early-stage dementia (0.33 points lower; P<0.001) compared to cognitively normal patients. Interviews identified themes that may explain these findings including physicians assumed patients with MCI, compared with cognitively normal patients, have limited life expectancy, frailty and

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Section: Plos Onementioning

confidence: 99%

Physician decision-making and recommendations for stroke and myocardial infarction treatments in older adults with mild cognitive impairment

et al. 2020

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“…Two studies analyzing postoperative cognitive outcomes of CABG particularly aimed their investigation at relatively young adults with a mean age of 54 ± 8 years 27 and 56 ± 6 years. 28 Several studies focused on older adults with a mean age ranging from 71 ± 9 to 75 ± 8 years. 29 – 31 Study samples ranged from 17 to 4752 patients with a median number of 101 participants.…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies were described as cross-sectional studies, 31 – 41 eight were comparative studies, 42 – 49 five were randomized controlled trials, 50 – 54 and two were retrospective cohort studies. 30 , 55 The remaining studies were a prospective cohort study, 29 an observational study, 27 a follow-up study, 28 a case-control study, 56 a longitudinal study, 57 and an interventional study. 58 …”

Section: Resultsmentioning

confidence: 99%

Cognitive function in patients with coronary artery disease: A literature review

et al. 2018

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ObjectiveCognitive function impairment is a well-documented complication of cerebrovascular disease (CBVD). Less is known about what factors affect the deterioration of cognitive function in patients with coronary artery disease (CAD). The aim of this review is to explore recent studies investigating factors associated with cognitive function in patients with CAD.MethodsStudies published from 2010 to 2016 were identified through a systematic search of MEDLINE/PubMed and were included if they addressed factors affecting cognitive function in the CAD population.ResultsOf the 227 publications identified, 32 were selected for the review. Five factors tentatively affecting cognitive function in patients with CAD were identified: coronary artery bypass grafting (CABG) surgery, apolipoprotein E4 (APOE4) genotype, left ventricular ejection fraction (LVEF), medication use, and various hormones and biomarkers.ConclusionNew techniques in CABG surgery have proven to alleviate postoperative cognitive decline. Researchers are still debating the effects of APOE4 genotype, LVEF, and the use of cardiovascular medications on cognitive function. Thyroid hormones and biomarkers are associated with cognitive function, but the exact nature of the association is debatable. Longitudinal studies should clarify those associations. In addition, cross-sectional studies addressing other causes of cognitive decline in patients with CAD are warranted.

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“…43 Studies also suggest that the risks and outcomes (cognition, mental functioning, physical functioning, and disease-specific quality of life) of AMI treatments, including revascularization, are similar between patients with MCI and cognitively normal patients. 44,47 Our study has several strengths. The HRS is a nationally representative study with rigorously collected data.…”

Section: Discussionmentioning

confidence: 99%

Mild Cognitive Impairment and Receipt of Treatments for Acute Myocardial Infarction in Older Adults

et al. 2019

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BACKGROUND: Older adults with mild cognitive impairment (MCI) should receive evidence-based treatments when indicated. Providers and patients may overestimate the risk of dementia in patients with MCI leading to potential under-treatment. However, the association between pre-existing MCI and receipt of evidence-based treatments is uncertain. OBJECTIVE: To compare receipt of treatments for acute myocardial infarction (AMI) between older adults with pre-existing MCI and cognitively normal patients. DESIGN: Prospective study using data from the nationally representative Health and Retirement Study, Medicare, and American Hospital Association. PARTICIPANTS: Six hundred nine adults aged 65 or older hospitalized for AMI between 2000 and 2011 and followed through 2012 with pre-existing MCI (defined as modified Telephone Interview for Cognitive Status score of 7-11) and normal cognition (score of 12-27). MAIN MEASURES: Receipt of cardiac catheterization and coronary revascularization within 30 days and cardiac rehabilitation within 1 year of AMI hospitalization. KEY RESULTS: Among the survivors of AMI, 19.2% had pre-existing MCI (55.6% were women and 44.4% were male, with a mean [SD] age of 82.3 [7.5] years), and 80.8% had normal cognition (45.7% were women and 54.3% were male, with a mean age of 77.1 [7.1] years). Survivors of AMI with pre-existing MCI were significantly less likely than those with normal cognition to receive cardiac catheterization (50% vs 77%; P < 0.001), coronary revascularization (29% vs 63%; P < 0.001), and cardiac rehabilitation (9% vs 22%; P = 0.001) after AMI. After adjusting for patient and hospital factors, pre-existing MCI remained associated with lower use of cardiac catheterization (adjusted hazard ratio (aHR), 0.65; 95% CI, 0.48-0.89; P = 0.007) and coronary revascularization (aHR, 0.55; 95% CI, 0.37-0.81; P = .003), but not cardiac rehabilitation (aHR, 1.01; 95% CI, 0.49-2.07; P = 0.98). CONCLUSIONS: Pre-existing MCI is associated with lower use of cardiac catheterization and coronary revascularization but not cardiac rehabilitation after AMI.

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Does Preoperative Mild Cognitive Impairment Predict Postoperative Cognitive Dysfunction after On-Pump Coronary Bypass Surgery?

Abstract: Our results show that the presence of MCI is not the leading cause of either early or long-term POCD in patients undergoing CABG. Further research should focus on the contribution of important clinical factors, including progression of atherosclerosis and adherence, to post-CABG POCD.

Cited by 17 publications

References 19 publications

Physician decision-making and recommendations for stroke and myocardial infarction treatments in older adults with mild cognitive impairment

Physician decision-making and recommendations for stroke and myocardial infarction treatments in older adults with mild cognitive impairment

Cognitive function in patients with coronary artery disease: A literature review

Mild Cognitive Impairment and Receipt of Treatments for Acute Myocardial Infarction in Older Adults

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