Lisbeth A Evered1, Brendan S Silbert, David A Scott, Paul Maruff, David Ames. 1. From the Department of Anaesthesia and Acute Pain Medicine, Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital, Melbourne, Australia (L.A.E., B.S.S., D.A.S.); Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Melbourne, Australia (L.A.E., B.S.S., D.A.S.); Florey Institute for Neuroscience and Mental Health, Parkville, Victoria, Australia (P.M.); and Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, and National Ageing Research Institute, Parkville, Victoria, Australia (D.A.).
Abstract
BACKGROUND: Although postoperative cognitive dysfunction (POCD) is well described after coronary artery bypass graft (CABG) surgery, a major concern has been that a progressive decline in cognition will ultimately lead to dementia. Since dementia interferes with the ability to carry out daily functions, the impact has far greater ramifications than cognitive decline defined purely by a decreased ability to perform on a battery of neurocognitive tests. The authors hypothesized that early cognitive impairment measured as baseline cognitive impairment is associated with an increased risk of long-term dementia. METHODS: The authors conducted a prospective longitudinal study on 326 patients aged 55 yr and older at the time of undergoing CABG surgery. Dementia was classified by expert opinion on review of performance on the Clinical Dementia Rating Scale and several other assessment tasks. Patients were also assessed for POCD at 3 and 12 months and at 7.5 yr using a battery of neuropsychologic tests and classified using the reliable change index. Associations were assessed using univariable analysis. RESULTS: At 7.5 yr after CABG surgery, the prevalence of dementia was 36 of 117 patients (30.8%; 95% CI, 23 to 40). POCD was detected in 62 of 189 patients (32.8%; 95% CI, 26 to 40). Due to incomplete assessments, the majority (113 patients), but not all, were assessed for both dementia and POCD. Fourteen of 32 (44%) patients with dementia were also classified as having POCD. Preexisting cognitive impairment and peripheral vascular disease were both associated with dementia 7.5 yr after CABG surgery. POCD at both 3 (odds ratio, 3.06; 95% CI, 1.39 to 9.30) and 12 months (odds ratio, 4.74; 95% CI, 1.63 to 13.77) was associated with an increased risk of mortality by 7.5 yr. CONCLUSIONS: The prevalence of dementia at 7.5 yr after CABG surgery is greatly increased compared to population prevalence. Impaired cognition before surgery or the presence of cardiovascular disease may contribute to the high prevalence.
BACKGROUND: Although postoperative cognitive dysfunction (POCD) is well described after coronary artery bypass graft (CABG) surgery, a major concern has been that a progressive decline in cognition will ultimately lead to dementia. Since dementia interferes with the ability to carry out daily functions, the impact has far greater ramifications than cognitive decline defined purely by a decreased ability to perform on a battery of neurocognitive tests. The authors hypothesized that early cognitive impairment measured as baseline cognitive impairment is associated with an increased risk of long-term dementia. METHODS: The authors conducted a prospective longitudinal study on 326 patients aged 55 yr and older at the time of undergoing CABG surgery. Dementia was classified by expert opinion on review of performance on the Clinical Dementia Rating Scale and several other assessment tasks. Patients were also assessed for POCD at 3 and 12 months and at 7.5 yr using a battery of neuropsychologic tests and classified using the reliable change index. Associations were assessed using univariable analysis. RESULTS: At 7.5 yr after CABG surgery, the prevalence of dementia was 36 of 117 patients (30.8%; 95% CI, 23 to 40). POCD was detected in 62 of 189 patients (32.8%; 95% CI, 26 to 40). Due to incomplete assessments, the majority (113 patients), but not all, were assessed for both dementia and POCD. Fourteen of 32 (44%) patients with dementia were also classified as having POCD. Preexisting cognitive impairment and peripheral vascular disease were both associated with dementia 7.5 yr after CABG surgery. POCD at both 3 (odds ratio, 3.06; 95% CI, 1.39 to 9.30) and 12 months (odds ratio, 4.74; 95% CI, 1.63 to 13.77) was associated with an increased risk of mortality by 7.5 yr. CONCLUSIONS: The prevalence of dementia at 7.5 yr after CABG surgery is greatly increased compared to population prevalence. Impaired cognition before surgery or the presence of cardiovascular disease may contribute to the high prevalence.
Authors: Miles Berger; Niccolò Terrando; S Kendall Smith; Jeffrey N Browndyke; Mark F Newman; Joseph P Mathew Journal: Anesthesiology Date: 2018-10 Impact factor: 7.892
Authors: Ganesh M Babulal; Yakeel T Quiroz; Benedict C Albensi; Eider Arenaza-Urquijo; Arlene J Astell; Claudio Babiloni; Alex Bahar-Fuchs; Joanne Bell; Gene L Bowman; Adam M Brickman; Gaël Chételat; Carrie Ciro; Ann D Cohen; Peggye Dilworth-Anderson; Hiroko H Dodge; Simone Dreux; Steven Edland; Anna Esbensen; Lisbeth Evered; Michael Ewers; Keith N Fargo; Juan Fortea; Hector Gonzalez; Deborah R Gustafson; Elizabeth Head; James A Hendrix; Scott M Hofer; Leigh A Johnson; Roos Jutten; Kerry Kilborn; Krista L Lanctôt; Jennifer J Manly; Ralph N Martins; Michelle M Mielke; Martha Clare Morris; Melissa E Murray; Esther S Oh; Mario A Parra; Robert A Rissman; Catherine M Roe; Octavio A Santos; Nikolaos Scarmeas; Lon S Schneider; Nicole Schupf; Sietske Sikkes; Heather M Snyder; Hamid R Sohrabi; Yaakov Stern; Andre Strydom; Yi Tang; Graciela Muniz Terrera; Charlotte Teunissen; Debora Melo van Lent; Michael Weinborn; Linda Wesselman; Donna M Wilcock; Henrik Zetterberg; Sid E O'Bryant Journal: Alzheimers Dement Date: 2018-12-13 Impact factor: 21.566
Authors: Elizabeth Mahanna-Gabrielli; Katie J Schenning; Lars I Eriksson; Jeffrey N Browndyke; Clinton B Wright; Deborah J Culley; Lis Evered; David A Scott; Nae Yah Wang; Charles H Brown; Esther Oh; Patrick Purdon; Sharon Inouye; Miles Berger; Robert A Whittington; Catherine C Price; Stacie Deiner Journal: Br J Anaesth Date: 2019-08-19 Impact factor: 9.166
Authors: L Evered; B Silbert; D S Knopman; D A Scott; S T DeKosky; L S Rasmussen; E S Oh; G Crosby; M Berger; R G Eckenhoff Journal: Br J Anaesth Date: 2018-06-15 Impact factor: 9.166
Authors: Keith W VanDusen; Sarada Eleswarpu; Eugene W Moretti; Michael J Devinney; Donna M Crabtree; Daniel T Laskowitz; Marty G Woldorff; Kenneth C Roberts; John Whittle; Jeffrey N Browndyke; Mary Cooter; Frank W Rockhold; Oke Anakwenze; Michael P Bolognesi; Mark E Easley; Michael N Ferrandino; William A Jiranek; Miles Berger Journal: J Alzheimers Dis Date: 2020 Impact factor: 4.472
Authors: Elizabeth L Whitlock; L Grisell Diaz-Ramirez; Alexander K Smith; W John Boscardin; Kenneth E Covinsky; Michael S Avidan; M Maria Glymour Journal: JAMA Date: 2021-05-18 Impact factor: 56.272
Authors: Connor T A Brenna; Beverley A Orser; Sinziana Avramescu; Andrew Fleet; Lilia Kaustov; Stephen Choi Journal: Brain Behav Date: 2021-03-04 Impact factor: 2.708