Intellectual and Personality Changes Following Open-Heart Surgery

Gilberstadt, Harold; Sako, Yoshio

doi:10.1001/archpsyc.1967.01730200078011

Cited by 80 publications

(17 citation statements)

References 7 publications

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“…Kimball [4] found a "substantial number of patients manifesting or reporting cognitive deficits both before and after surgery." The prominence of organic phenomena, however, is not usually sufficient in degree to impair adjustment in most surviving patients [6]. We tend to agree with Kimball [4] that "The behavioral reactions observed in the postoperative period suggest the complex interplay of factors interposed at every stage .…”

supporting

confidence: 72%

Ego-Supportive Care in Open-Heart Surgery

Abramson

Block

1973

Psychiatry in Medicine

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Open heart surgery has been shown to have a rate of occurrence of postoperative psychopathological phenomena (9 percent-57 percent) many times greater than that of general surgery (1/1500). These phenomena result from an interplay of organic, environmental, psychological, and social factors which act on the integrative and coping capacity of the ego.Treatment is accomplished through support of the ego by: 1) establishment of a relationship, 2) reassurance, 3) environmental support, 4) consultative relationships with staff, 5 ) ventilation of feelings, 6) medical measures in support of somatic function, and 7) anti-anxiety drugs. Such supportive measures are usually effective in bringing about a rapid remission of these psychopathological phenomena.

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supporting

confidence: 72%

Ego-Supportive Care in Open-Heart Surgery

Abramson

Block

1973

Psychiatry in Medicine

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“…In another study with one year's follow-up, Heller et al 12 stated that although over 90% of the patients showed improvement in their physical condition compared with preoperative evaluation, general psychological adjustment declined. Other studies with shorter follow-up times 13 " 13 have revealed disturbances in memory, attention span, perceptualmotor coordination and psychomotor speed. Contrary to the above mentioned studies in adult patients, investigations in children 30 ' 31 have failed to verify psychomotor or intellectual disturbances after cardiac operations.…”

mentioning

confidence: 94%

Long-term cerebral outcome after open-heart surgery. A five-year neuropsychological follow-up study.

Sotaniemi¹,

Mononen²,

Hokkanen³

1986

Stroke

189

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SUMMARY A prospective 5 years' neuropsychological, neurological, cardiological and electroencephalographkal follow-up study was carried out in 44 patients who had undergone open-heart surgery for valve replacement. A distinct interrelationship was found between the clinical outcome immediately after operation and the neuropsychological long-term course despite the rapid recovery of occasional clinical disorders related to operative procedures. In fact, the psychometric performance scores of those who did not develop clinical signs of cerebral dysfunction induced in operation showed a significant difference only years after operation. Similarly, the harmful effects of long perfusion time (ertracorporeal circulation) in operation were reflected in the long-term neuropsychological performance. Some evidence seemed to suggest that the correction of the prolonged circulatory disorder might possibly afford real enhancement of higher cerebral functions. The long-term results not only emphasize the importance of a careful clinical evaluation but also emphasize the necessity of considering the subclinteal level of events both before and after operation when assessing the overall outcome and cerebral safety of cardiac surgery patients.Stroke Vol 17, No 3, 1986CENTRAL NERVOUS SYSTEM (CNS) dysfunction has occasionally cast a shadow over the results of cardiac surgery. The development of surgical and anaesthesiological equipment has notably improved cerebral safety, and the occurrence of severe complications has become rare.'" 4 The well-being of the CNS, however, has not become self-evident and secure because several potentially harmful factors always remain in such complicated procedures as open-heart operations. It must also be emphasized that when only clinical criteria have been used to evaluate the CNS outcome, the appraisal of the results seems to have been too optimistic. 43 Clinical measures have been shown to provide only a narrow view over the actual CNS events, for the involvement of the subclinical levels has been revealed in electroencephalographical (EEG), 6 " 10 neuropsychological,"" 18 psychiatric 19 and radiological 20 studies.Previous studies investigating the long-term outcome of open-heart operations have concentrated their attention on cardiological and surgical aspects. "29 By contrast, the outcome of the higher cerebral functions has been given little attention, the earlier investigations having focused on describing the prevalence, nature and determinants of immediate postoperative disturbances using follow-up times limited to a few weeks or months."' l3 ' 16 Frank et al 16 performed a 6 months' study after operation and reported improvement in all the measured areas of intellectual performance. Preoperative anxiety seemed to worsen the improvement, probably by rendering the patients less apt to recall the test items. The intellectual changes were independent of cardiac functional measures. It was concluded that the observed improvement was only due to practice effects and that improved cerebral perf...

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“…Although some of the earliest cognitive outcomes studies did include control groups, 3,4 the trend for later studies was to measure within-subject changes in only the patients having surgery. This may have been partially because of the difficulty in finding a control group that matched the CABG surgery group in important respects.…”

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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Intellectual and Personality Changes Following Open-Heart Surgery

Cited by 80 publications

References 7 publications

Ego-Supportive Care in Open-Heart Surgery

Ego-Supportive Care in Open-Heart Surgery

Long-term cerebral outcome after open-heart surgery. A five-year neuropsychological follow-up study.

Neurocognitive complications after coronary artery bypass surgery

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