Impaired cognition preceding cardiac surgery is related to cerebral ischemic lesions

Maekawa, Kengo; Gotō, Tomoko; Baba, Tomoko; Yoshitake, Akihiro; Katahira, Kentaro; Yamamoto, Tatsuo

doi:10.1007/s00540-011-1108-5

Cited by 24 publications

(17 citation statements)

References 31 publications

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“…Lund et al [37] evaluated patients who had undergone an on-pump coronary artery bypass surgery and found that the severity of presurgical white matter abnormalities, a brain MRI variable associated with ischemia and small vessel vascular disease, predicted the frequency of postoperative cognitive impairment at 3 months postsurgery. Maekawa et al [38 • ] found that white matter lesions and cerebral infarctions on MRI scans were predictive of impaired cognition prior to elective cardiac surgery and placed these patients at a higher risk for postoperative neurological dysfunction. Similarly, preoperative white matter fractional anisotropy acquired via magnetic resonance diffusion methods has been associated with postoperative delirium [39 • ].…”

Section: Potential Mechanisms For Postoperative Cognitive Disordersmentioning

confidence: 99%

Postoperative cognitive disorders

Monk

Price

2011

Current Opinion in Critical Care

211

165

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Purpose of review The elderly are the fastest growing segment of the population and undergo 25–30% of all surgical procedures. Postoperative cognitive problems are common in older patients following major surgery. The socioeconomic implications of these cognitive disorders are profound; cognitive decline is associated with a loss of independence, a reduction in the quality of life, and death. This review will focus on the two most common cognitive problems following surgery: postoperative delirium and postoperative cognitive dysfunction (POCD). Recent findings For years, preoperative geriatric consultation/screening was the only intervention proven to decrease postoperative delirium. There are, however, several recent publications indicating that preoperative and postoperative pharmacological and medical (hydration, oxygenation) management can reduce postoperative delirium. Spinal anesthesia with minimal propofol sedation has been shown to decrease the incidence of postoperative delirium in hip-fracture patients. Likewise, dexmedetomidine sedation in mechanically ventilated patients in the ICU is associated with less postoperative delirium and shorter ventilator times. Preoperative levels of education and brain function (cognitive reserve) may predict patients at risk for postoperative cognitive problems. Reduced white matter integrity is reported to place patients at a higher risk for both postoperative delirium and POCD. Summary The etiology of postoperative cognitive problems is unknown, but there is emerging evidence that decreased preoperative cognitive function contributes to the development of postoperative delirium and POCD. There is growing concern that inhalation anesthetics may be neurotoxic to the aging brain, but there are no human data evaluating this hypothesis to date. Randomized controlled trials evaluating interventions to improve long-term cognitive outcomes in elderly patients are urgently needed.

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Section: Potential Mechanisms For Postoperative Cognitive Disordersmentioning

confidence: 99%

Postoperative cognitive disorders

Monk

Price

2011

Current Opinion in Critical Care

211

165

View full text Add to dashboard Cite

show abstract

“…Factors negatively related to the condition of blood vessels, including those of the brain, such as advanced age, preexisting (cerebro)vascular disease, and the presence of (cerebro) vascular risk factors, play an important role in the pathogenesis of cognitive dysfunction after cardiac surgery. In fact, preoperative small ischaemic lesions and cognitive impairment have been reported in a considerable proportion of candidates for cardiac surgery and have been shown to be predictors of both early and late postoperative cognitive dysfunction [11,12]. It has been suggested that the apolipoprotein E (APOE) ε4 allele, a genetic risk factor for both atherosclerosis and Alzheimer's disease, plays an explanatory role.…”

Section: Patient-related Factorsmentioning

confidence: 99%

Cognitive dysfunction after cardiac surgery: Pathophysiological mechanisms and preventive strategies

Bruggemans

2012

Neth Heart J

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Despite improvements in surgical techniques and the implementation of effective brain protection strategies, the incidence of brain injury after cardiac surgery has remained relatively constant over the years as patients have become older and sicker. Cognitive dysfunction is the most common clinical manifestation of brain injury after cardiac surgery. Its occurrence is related to a combination of three factors that are often associated with cardiopulmonary bypass (CPB): embolism, hypoperfusion, and the inflammatory response. However, such factors and their potential cerebral consequences are not exclusive to CPB. Postoperative cognitive dysfunction also afflicts patients who undergo cardiac surgery without CPB as well as nonsurgery patients who undergo transcatheter interventions. There is growing evidence that patient-related factors such as the presence of (cerebro)vascular risk factors play an important role in both early and late postoperative cognitive dysfunction.

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“…5,6 To determine whether the patient had POCD, we compared groups using an absolute score (MMSEand MoCA-specific score), which is more practical in the clinical setting than relative methods used in previous studies (previous literature had used decrease in 0.5-1.0 SD or 20% of score as significant. 7 ) Both MMSE and MoCA tests were chosen because of their relative ease to perform, while including most of the important domains of cognitive function (orientation, memory, calculation, attention, abstraction, and executive function).…”

Section: Resultsmentioning

confidence: 99%

Association of CT perfusion and postoperative cognitive dysfunction after off-pump coronary artery bypass grafting

Song

Chen

et al. 2016

Neurological Research

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Impaired cognition preceding cardiac surgery is related to cerebral ischemic lesions

Abstract: These findings suggest that preoperative cognitive impairment associated with cerebral ischemic lesions and an increased risk of postoperative cognitive dysfunction existed in our patient cohort undergoing cardiac surgery.

Cited by 24 publications

References 31 publications

Postoperative cognitive disorders

Postoperative cognitive disorders

Cognitive dysfunction after cardiac surgery: Pathophysiological mechanisms and preventive strategies

Association of CT perfusion and postoperative cognitive dysfunction after off-pump coronary artery bypass grafting

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