Impact of Cognitive Dysfunction on Survival in Patients With and Without Statin Use Following Carotid Endarterectomy

Heyer, Éric; Mergeche, Joanna L.; Wang, Shuang; Gaudet, John G.; Connolly, E. Sander

doi:10.1227/neu.0000000000000904

Cited by 19 publications

(22 citation statements)

References 53 publications

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“…We further cannot rule out influences of delirium on cognitive status in studies with brief follow‐up periods (e.g. ) on our findings. A majority of investigations that we included in our analysis were exploratory, which hindered identification of articles, and our search strategy did not include any domain‐specific terms.…”

Section: Discussionmentioning

confidence: 85%

Obesity and post‐operative cognitive dysfunction: a systematic review and meta‐analysis

Feinkohl

Winterer

Pischon

2016

Diabetes Metabolism Res

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Obesity and post-operative cognitive dysfunction: a systematic review and meta-analysis Feinkohl, I. and Winterer, G. and Pischon, T. This is the final version of the manuscript. It is the peer reviewed version of the following article: Email: insa.feinkohl@mdc-berlin.de Abstract Background Post-operative cognitive dysfunction (POCD) occurs frequently after surgery, and is related to dementia and premature death. Obesity increases the risk of late-life cognitive impairment, but little is known about its role in POCD. We conducted a systematic review and metaanalysis of studies on the association between obesity and risk of POCD. Methods PubMed and the Cochrane Library were systematically searched. Studies were included if they had prospective designs, reported on human adults undergoing surgery, if cognitive function was measured pre-and post-surgery, if obesity, body mass index (BMI) and/or body weight were ascertained, and if associations with POCD were reported as relative risks or odds ratios. Underweight, weight loss, and post-operative delirium were not considered. Results Inclusion criteria were met by six articles. Samples totaled 1432 older patients (mean age ≥62 years) who were followed up for 24 hours to twelve months after surgery. Analysis of studies with obesity defined as a categorical measure found a non-significantly higher risk of POCD among persons with BMI>30 kg/m 2 versus ≤30 kg/m 2 (RR 1.27; 95% CI 0.95, 1.70; p=0.10). No such associations were found for studies that analyzed BMI or body weight continuously as predictors of POCD (RR 0.98 per kg/m 2 ; 95% CI 0.93, 1.03, p=0.45; RR 0.99 per kg; 95% CI 0.89, 1.09; p=0.83, respectively). Conclusions Few studies have addressed the topic, and the results of these studies provide only limited support for an increased risk of POCD in patients who are obese. Further large-scale, prospective investigations are necessary for clarification.Keywords: obesity, body weight, adiposity, post-operative cognitive dysfunction, POCD. Table): 3129 Introduction Post-operative cognitive dysfunction (POCD) is a frequent condition that may occur after any type of surgery. POCD broadly refers to a "deterioration in cognition temporally associated with surgery" [1]. In contrast to post-operative delirium (POD), POCD is characterized by intact consciousness and a more subtle onset [2], and it is thought to be caused by distinct pathology. POCD is considered as a transient condition [3], but disease progression and resulting cognitive trajectories of POCD vary substantially between individuals [4] and depend on the time since surgery. Overall incidence rates in older age groups range between 10-38% [5][6][7][8] within the first 2 to 3 months and 3-24% at 6 to 12 months after surgery [7,9,10]. Further, POCD appears to increase the risk of subsequent dementia diagnosis as well as premature death [3,6,11,12]. The etiology and pathophysiology of POCD are relatively unclear, and only a few risk factors have been identified to date, including higher age and preexisting cog...

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Section: Discussionmentioning

confidence: 85%

Obesity and post‐operative cognitive dysfunction: a systematic review and meta‐analysis

Feinkohl

Winterer

Pischon

2016

Diabetes Metabolism Res

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“…Thus, full texts of 40 articles were accessed. Six articles qualified for inclusion of which 3 were excluded [34-36] due to suspected duplicate reporting of other articles with more complete reporting [9, 30, 37]. Twelve articles that addressed the research question were excluded due to failing to formally meet inclusion criteria but were considered qualitatively in sensitivity analyses.…”

Section: Resultsmentioning

confidence: 99%

“…Screening of reference lists and an independent search identified 22 further relevant studies of which 21 met inclusion criteria. Overall, 24 articles were included [6, 9, 25-30, 37, 39-53]. …”

Section: Resultsmentioning

confidence: 99%

“…POCD is considered transient [2] but may remain detectable for months and years after surgery [3]. In patients with persistent POCD, it is known to negatively impact on everyday life tasks [4], quality of life [5], subjective memory performance [6], emotional symptoms [7], and may predict more severe health consequences such as dementia and premature mortality [2, 8, 9]. Both the prevalence of hypertension and the likelihood of major surgery increase with advanced age [10-13].…”

Section: Introductionmentioning

confidence: 99%

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Hypertension and Risk of Post-Operative Cognitive Dysfunction (POCD): A Systematic Review and Meta-Analysis

Feinkohl¹,

Winterer²,

Pischon³

2017

CPEMH

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Background:Post-operative cognitive dysfunction (POCD) occurs frequently after major surgery. Hypertension is well-established as a risk factor for age-related cognitive impairment, but it is unclear whether or not it also increases the risk of POCD.Objective:To evaluate the role of hypertension in POCD risk in a systematic review and meta-analysis.Method:PubMed, Ovid SP and the Cochrane Database of Systematic Reviews were searched for longitudinal studies of adults undergoing surgery with reporting of hypertension, blood pressure and/or anti-hypertensive treatment associations with POCD as relative risks or odds ratios. Fixed-effects meta-analyses were performed using Review Manager (version 5.3).Results:Twenty-four studies on 4317 patients (mean age 63 years) were included. None of the studies had set out to assess hypertension as a risk factor for POCD. Hypertension was used as a categorical predictor throughout and only 2 studies adjusted for potential confounders. Across all 24 studies, hypertension was not significantly associated with POCD risk (RR 1.01; 95% CI 0.93, 1.09; p=0.82), though among 8 studies with >75% males, we found hypertension associations with a 27% increased risk of POCD (RR 1.27, 95% CI 1.07, 1.49; p=0.005).Conclusion:Our findings do not support the hypothesis that hypertension is a risk factor for POCD. However, since none of the studies included in our analysis were hypothesis-driven and most did not adjust for potential confounders, further systematic investigations are needed to evaluate the role of hypertension in the epidemiology of POCD.

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“…Because of poor characterization of the syndrome and resulting lack of diagnostic criteria, substantial variation exists in reported incidence rates, but in older age groups, incidence overall appears in the order of 10% to 38% within the first 2 to 3 months and 3% to 24% at 6 to 12 months after major surgery . Although it is considered a transient condition, POCD has been shown to increase the risk of subsequent dementia as well as premature death; yet research into its epidemiology—which may elucidate its etiology as well as preventive strategies—is lagging behind. Only a few risk factors for POCD have been identified to date, including advanced age and preexisting cognitive impairment …”

Section: Introductionmentioning

confidence: 99%

Diabetes is associated with risk of postoperative cognitive dysfunction: A meta‐analysis

Feinkohl

Winterer

Pischon

2017

Diabetes Metabolism Res

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Impact of Cognitive Dysfunction on Survival in Patients With and Without Statin Use Following Carotid Endarterectomy

Abstract: aHR, adjusted hazards ratiosCEA, carotid endarterectomyCI, confidence intervalDM, diabetes mellituseCD, early cognitive dysfunctionNDI, National Death IndexNLR, neutrophil/lymphocyte ratioSD, standard deviationSEM, standard error of the mean.

Cited by 19 publications

References 53 publications

Obesity and post‐operative cognitive dysfunction: a systematic review and meta‐analysis

Obesity and post‐operative cognitive dysfunction: a systematic review and meta‐analysis

Hypertension and Risk of Post-Operative Cognitive Dysfunction (POCD): A Systematic Review and Meta-Analysis

Diabetes is associated with risk of postoperative cognitive dysfunction: A meta‐analysis

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