Postoperative cognitive change after cardiac surgery predicts long‐term cognitive outcome

Relander, Kristiina; Hietanen, Marja; Rantanen, Kirsi; Rämö, Juhani; Vento, Antti; Saastamoinen, Kari-Pekka; Roine, Risto O.; Soinne, Lauri

doi:10.1002/brb3.1750

Cited by 39 publications

(51 citation statements)

References 37 publications

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“…In contrast to postoperative deterioration, no significant associations were found between mortality and POCI in either postoperative assessment. These findings are in agreement with our recent findings revealing that POCD, but not POCI, was associated with the course of long-term cognitive performance after cardiac surgery ( 21 ). However, POCI after cardiac surgery is probably related to better cardiac functioning that improves overall health, ( 22 ) while after CEA it may follow from improvement in cerebral hemodynamics and the associated neuronal metabolism ( 7 , 8 , 10 ).…”

Section: Discussionsupporting

confidence: 94%

“…Indeed, although not diagnosed at the time of recruitment, a few patients in the POCD group, but none in the no POCD group, later died of Alzheimer's disease. Associations between POCD after CEA and neurodegenerative disease have not yet been studied, but associations between POCD after cardiac surgery and long-term cognitive decline have been found ( 11 , 21 , 28 , 29 ). Future studies should address the associations between POCD after CEA, long-term cognitive deterioration and neurodegenerative diseases.…”

Section: Discussionmentioning

confidence: 99%

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Cognitive Dysfunction and Mortality After Carotid Endarterectomy

et al. 2021

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Background: Carotid endarterectomy (CEA) has been associated with both postoperative cognitive dysfunction (POCD) and improvement (POCI). However, the prognostic significance of postoperative cognitive changes related to CEA is largely unknown. The aim of this study was to examine the associations between postoperative cognitive changes after CEA and long-term survival.Methods: We studied 43 patients 1 day before CEA as well as 4 days and 3 months after surgery with an extensive neuropsychological test array, and followed them for up to 14 years. POCD and POCI relative to baseline were determined with the reliable change index derived from 17 healthy controls. Associations between POCD/POCI and mortality within the patient group were studied with Cox regression analyses adjusted for confounders.Results: POCD in any functional domain was evident in 28% of patients 4 days after surgery and in 33% of patients 3 months after surgery. POCI was shown in 23% of patients at 4 days and in 44% of patients at 3 months. POCD at 3 months was associated with higher long-term mortality (hazard ratio 5.0, 95% CI 1.8–13.9, p = 0.002) compared with patients with no cognitive decline.Conclusions: Our findings suggest that POCD in a stable phase, 3 months after CEA predicts premature death. Evaluation of postoperative cognitive changes is essential, and POCD in a stable phase after CEA should prompt scrutiny of underlying factors and better adherence to therapies to prevent recurrences and to promote early intervention in imminent deterioration.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

et al. 2021

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“…There are, however, some limitations, most importantly the restricted sample size resulting in reduced statistical power. Indeed, some previously reported differences between the CABG group and controls with the same data (10) did not reach significance in this study. Considering the restrictions in sample size, the clear differences between the patient groups in the present study indicate a rather robust finding.…”

Section: Discussionsupporting

confidence: 44%

“…Postoperative cognitive impairment after CEA or CABG has been associated with lower quality of life (34), adverse long-term cognition (10,(35)(36)(37) and higher mortality (35,38,39). However, differences in postoperative cognitive outcome between CABG and CEA are yet to be investigated.…”

Section: Introductionmentioning

confidence: 99%

Differential Cognitive Functioning and Benefit From Surgery in Patients Undergoing Coronary Artery Bypass Grafting and Carotid Endarterectomy

et al. 2022

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BackgroundStenosing atherosclerosis in both coronary and carotid arteries can adversely affect cognition. Also their surgical treatments, coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA), are associated with cognitive changes, but the mechanisms of cognitive decline or improvement may not be the same. This study was designed to compare the cognitive profile and outcome in patients undergoing surgical treatment for coronary or carotid disease.MethodsA total of 100 CABG patients and 44 CEA patients were recruited in two previously reported studies. They were subjected to a comprehensive neuropsychological examination prior to surgery and in the acute (3–8 days) and stable (3 months) phase after operation. A group of 17 matched healthy controls were assessed with similar intervals. We used linear mixed models to compare cognitive trajectories within six functional domains between the CABG, CEA and control groups. Postoperative cognitive dysfunction (POCD) and improvement (POCI) were determined with the reliable change index method in comparison with healthy controls.ResultsBefore surgery, the CEA patients performed worse than CABG patients or healthy controls in the domains of executive functioning and processing speed. The CABG patients exhibited postoperative cognitive dysfunction more often than the CEA patients in most cognitive domains in the acute phase but had regained their performance in the stable phase. The CEA patients showed more marked postoperative improvement in executive functioning than the CABG group in the acute phase, but the difference did not reach significance in the stable phase.ConclusionOur findings suggest that anterior cerebral dysfunction in CEA patients impairs preoperative cognition more severely than global brain dysfunction in CABG patients. However, CEA may have more beneficial effects on cognition than CABG, specifically in executive functions mainly operated by the prefrontal lobes. In addition, the results underline that POCD is a heterogeneous condition and dependent on type of revascularization surgery.

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“…Additionally, patients in the dexamethasone group were quicker in perception and response execution, i.e., in the domain of psychomotor speed. Relander et al showed that the most consistently impaired cognitive domain during six years of follow-up after cardiac surgery was executive functioning, probably because of the complex and widespread neurocognitive network necessary for daily functioning [ 22 ]. Our results suggest that the prophylactic administration of dexamethasone is particularly effective at preserving this area of cognitive performance following cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal assessment of preoperative dexamethasone administration on cognitive function after cardiac surgery: a 4-year follow‐up of a randomized controlled trial

et al. 2021

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Background The pathogenesis of postoperative cognitive decline (POCD) is still poorly understood; however, the inflammatory response to surgical procedures seems likely to be involved. In addition, our recent randomized controlled trial showed that perioperative corticosteroid treatment may ameliorate early POCD after cardiac surgery. To assess the long-term effect of dexamethasone administration on cognitive function, we conducted a 4-year follow-up. Methods The patients were randomized to receive a single intravenous bolus of 0.1 mg kg− 1 dexamethasone or placebo 10 h before elective cardiac surgery. The endpoint in both groups was POCD incidence on the 6th day and four years postoperatively. Results Of the 161 patients analyzed previously, the current follow-up included 116 patients. Compared to the 62 patients in the placebo group, the 54 patients in the dexamethasone group showed a lower incidence of POCD on the 6th day (relative risk (RR), 0.510; 95 % confidence interval (CI), 0.241 to 1.079; p = 0.067, time interval also analyzed previously) and four years (RR, 0.459; 95 % CI, 0.192 to 1.100; p = 0.068) after cardiac surgery. The change in cognitive status between the two postoperative measurements was not significant (p = 0.010) among the patients in the dexamethasone group, in contrast to patients in the placebo group (p = 0.673). Conclusions Although statistical significance was not reached in the current study, the prophylactic administration of dexamethasone seems to be useful to prevent POCD development following cardiac surgery. However, further large multicenter research is needed to confirm these directions. Trial registration ClinicalTrials.gov identifier: NCT02767713 (10/05/2016).

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Postoperative cognitive change after cardiac surgery predicts long‐term cognitive outcome

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 39 publications

References 37 publications

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Differential Cognitive Functioning and Benefit From Surgery in Patients Undergoing Coronary Artery Bypass Grafting and Carotid Endarterectomy

Longitudinal assessment of preoperative dexamethasone administration on cognitive function after cardiac surgery: a 4-year follow‐up of a randomized controlled trial

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