Late Cognitive Impairment After Coronary Bypass Graft Surgery: Opportunities in Rehabilitation with the Use of Computer-Based Training

Abstract

In spite of recent significant advances in reduction of mortality and disability, coronary heart disease (CHD) remains widespread both in Russia and around the world. Coronary bypass graft surgery (CABG) has proved to be the most effective method of CHD treatment, providing that conservative therapy is not effective enough. The aim of the present study was to reveal and correct postoperative cognitive dysfunction (POCD), developed under the conditions of cardiopulmonary bypass (CB) in patients with CHD within 12 months after CABG. A total of 87 patients were examined, all the patients underwent a course of drug therapy, 50 patients underwent a course of rehabilitation using computer-based stimulation programmes (once per day for 20 minutes within 10 days) in addition to medical therapy. A reliable improvement in results of the conducted research suggests that the proposed method provides safety and high performance in cognitive rehabilitation of patients with impairments of the higher brain functions after CABG. A relatively short course of rehabilitation (10 days) corresponded to the length of hospital stay of patients in the cardiac unit. However, even in such a short course we could obtain significant advantage in terms of efficiency of higher cortical functions recovery. Therefore, a course of rehabilitation using computer-based stimulation programmes in patients with coronary heart disease after CABG was proved to be an effective way of correcting cognitive function.

Nonpharmacological Cognitive Impairment Prevention Interventions in Older Adults Undergoing Cardiac Surgery

“…10,[28][29][30][31][32][33][34][35][36] Another 8 studies were fair, meaning they were susceptible to some bias considered not sufficient to invalidate their results. [37][38][39][40][41][42][43][44] One was considered poor. 45 Limitations of the studies included in this review were inconsistent operational definitions for cognitive impairment and diagnostic criteria, domains of cognition assessed, choice of cognitive tests, timing of assessments, and surgical procedure (sample sizes for patients undergoing valve repair or replacement were very small, and none included only valve procedures).…”

“…Of the 19 included studies, 3 each were in Germany, 32,41,42 the United States, 30,33,35 the United Kingdom, 10,34,44 and Iran [36][37][38] ; 2 each in Croatia 28,29 and Russia 43,45 ; and 1 each in Korea, 39 Canada, 40 and Turkey. 31 Most studies were single-site (n = 16) 10,[28][29][30][31][33][34][35][36][37][38][39][40]42,43,45 pilot studies (n = 7), 10,30,31,34,39,40,42 with small samples of less than 150 participants (n = 13) [29][30][31][33][34][35][36][37]…”

“…We evaluated 6 interventions: remote ischemic limb preconditioning, 29,30,32,38,39,41,42 cerebral oxygenation monitoring, 28,31,[33][34][35]44 computerized cognitive training, 37,43,45 visual feedback using structured mirrors, family engagement, 40 and multimedia education. 36 The most common intervention studied was remote ischemic limb preconditioning.…”

“…The use of computerized cognitive training to improve cognitive functioning was evaluated in 3 studies. 37,43,45 Computerized cognitive training uses restorative exercise drills and development of compensatory strategies designed to increase cognitive function in specific domains rather than memory or problem-solving remediation. 37,43,45 The intervention design across studies delivered 20-minute sessions before surgery but differed in number and frequency of training sessions after surgery.…”

“…Improvements in global cognitive function, memory, attention, language fluency, and executive functioning were retained for up to 1 year after surgery. 37,43,45 Visual Feedback Using Structured Mirrors. The use of unbreakable mirrors included (1) having the patient look at his/her own face (eg, speech therapy) and ( 2) posture (physical/occupational therapy) to improve proprioception.…”