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Journal of Anesthesia

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20-01-2023 | Magnetic Resonance Imaging | Original Article

Predictors of early postoperative cognitive dysfunction in middle-aged patients undergoing cardiac surgery: retrospective observational study

Authors: Takafumi Oyoshi, Kengo Maekawa, Yuki Mitsuta, Naoyuki Hirata

Published in: Journal of Anesthesia | Issue 3/2023

Abstract

Purpose

This study aimed to identify the incidence and risk factors of early post-operative cognitive dysfunction (POCD) in middle-aged patients undergoing cardiac surgery.

Methods

Data were examined retrospectively from 71 patients aged 46–64 years who underwent elective cardiac surgery. Magnetic resonance imaging (MRI) and MR angiography were obtained preoperatively to assess prior cerebral infarctions, carotid artery stenosis, and intracranial arterial stenosis. Patients also completed six neuropsychological tests of memory, attention, and executive function before and after surgery. Mild cognitive impairment (MCI) was defined as performance 1.5 standard deviations (SD) below the population means on any neurocognitive battery, whereas POCD was defined as a decrease of 1 SD population means on at least two in the test battery. Patient characteristics were analyzed using univariate analysis, and independent predictors were analyzed using multivariate logistic regression analysis.

Results

After surgery, 25 patients (35%) were assessed with POCD. Patients with POCD had significantly higher rates of preoperative MCI and cerebral infarcts on MRI. Multivariate logistic regression analysis identified preoperative MCI and cerebral infarctions detected by MRI as a predictor of POCD.

Conclusion

More than one-third of middle-aged patients undergoing cardiac surgery developed POCD. Our findings suggested preoperative MCI and infarcts detected by MRI were risk factors for POCD in these middle-aged patients.

Monk TG, Weldon BC, Garvan CW, Dede DE, van der Aa MT, Heilman KM, Gravenstein JS. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108(1):18–30.PubMedCrossRef

Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, Mark DB, Reves JG, Blumenthal JA. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344(6):395–402.PubMedCrossRef

Newman MF, Grocott HP, Mathew JP, White WD, Landolfo K, Reves JG, Laskowitz DT, Mark DB, Blumenthal JA. Report of the substudy assessing the impact of neurocognitive function on quality of life 5 years after cardiac surgery. Stroke. 2001;32(12):2874–81.PubMedCrossRef

Steinmetz J, Christensen KB, Lund T, Lohse N, Rasmussen LS, ISPOCD Group. Long-term consequences of postoperative cognitive dysfunction. Anesthesiology. 2009;110(3):548–55.

Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999;56(3):303–8.PubMedCrossRef

Lopez OL, Kuller LH, Becker JT, Dulberg C, Sweet RA, Gach HM, Dekosky ST. Incidence of dementia in mild cognitive impairment in the cardiovascular health study cognition study. Arch Neurol. 2007;64(3):416–20.PubMedCrossRef

Petersen RC, Roberts RO, Knopman DS, Boeve BF, Geda YE, Ivnik RJ, Smith GE, Jack CR. Mild cognitive impairment: ten years later. Arch Neurol. 2009;66(12):1447–55.PubMedPubMedCentralCrossRef

Lu Y, Liu C, Yu D, Fawkes S, Ma J, Zhang M, Li C. Prevalence of mild cognitive impairment in community-dwelling Chinese populations aged over 55 years: a meta-analysis and systematic review. BMC Geriatr. 2021;21(1):10.PubMedPubMedCentralCrossRef

González HM, Tarraf W, Schneiderman N, Fornage M, Vásquez PM, Zeng D, Youngblood M, Gallo LC, Daviglus ML, Lipton RB, Kaplan R, Ramos AR, Lamar M, Thomas S, Chai A, DeCarli C. Prevalence and correlates of mild cognitive impairment among diverse Hispanics/Latinos: study of latinos-Investigation of neurocognitive aging results. Alzheimers Dement. 2019;15(12):1507–15.PubMedPubMedCentralCrossRef

10.

Szcześniak D, Rymaszewska J, Zimny A, Sąsiadek M, Połtyn-Zaradna K, Smith EE, Zatońska K, Zatoński T, Rangarajan S, Yusuf S, Szuba A. Cerebral small vessel disease and other influential factors of cognitive impairment in the middle-aged: a long-term observational cohort PURE-MIND study in Poland. GeroScience. 2021;43(1):279–95.PubMedCrossRef

11.

Rosengart TK, Sweet J, Finnin EB, Wolfe P, Cashy J, Hahn E, Marymont J, Sanborn T. Neurocognitive functioning in patients undergoing coronary artery bypass graft surgery or percutaneous coronary intervention: evidence of impairment before intervention compared with normal controls. Ann Thorac Surg. 2005;80(4):1327–35.PubMedCrossRef

12.

Maekawa K, Goto T, Baba T, Yoshitake A, Katahira K, Yamamoto T. Impaired cognition preceding cardiac surgery is related to cerebral ischemic lesions. J Anesth. 2011;25(3):330–6.PubMedCrossRef

13.

Murkin JM, Newman SP, Stump DA, Blumenthal JA. Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. Ann Thorac Surg. 1995;59(5):1289–95.PubMedCrossRef

14.

Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, Gamst A, Holtzman DM, Jagust WJ, Petersen RC, Snyder PJ, Carrillo MC, Thies B, Phelps CH. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the national institute on aging-Alzheimer’s association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):270–9.PubMedPubMedCentralCrossRef

15.

Rasmussen LS, Larsen K, Houx P, Skovgaard LT, Hanning CD, Moller JT, ISPOCD group. The assessment of postoperative cognitive function. Acta Anaesthesiol Scand. 2001;45(3):275–89.PubMedCrossRef

16.

Lewis MS, Maruff P, Silbert BS, Evered LA, Scott DA. The sensitivity and specificity of three common statistical rules for the classification of post-operative cognitive dysfunction following coronary artery bypass graft surgery. Acta Anaesthesiol Scand. 2006;50(1):50–7.PubMedCrossRef

17.

Heiserman JE, Drayer BP, Keller PJ, Fram EK. Intracranial vascular stenosis and occlusion: Evaluation with three-dimensional time-of-flight MR angiography. Radiology. 1992;185(3):667–73.PubMedCrossRef

18.

Atlas SW. MR angiography in neurologic disease. Radiology. 1994;193(1):1–16.PubMedCrossRef

19.

Masaryk TJ, Lewin JS, Laub G. Magnetic resonance angiography. In: Stark DD, Bradley WG, editors. Magnetic resonance imaging. 2nd ed. St Louis: Mosby Year Book; 1992. p. 299–313.

20.

Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol. 1987;149(2):351–6.PubMedCrossRef

21.

Needham MJ, Webb CE, Bryden DC, (2017) Postoperative cognitive dysfunction and dementia: what we need to know and do. Br J Anaesth 119 (suppl_1) i115-i125

22.

Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.PubMedCrossRef

23.

Rudolph JL, Schreiber KA, Culley DJ, McGlinchey RE, Crosby G, Levitsky S, Marcantonio ER. Measurement of post-operative cognitive dysfunction after cardiac surgery: a systematic review. Acta Anaesthesiol Scand. 2010;54(6):663–77.PubMedPubMedCentralCrossRef

24.

Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, Rabbitt P,Jolles J, Larsen K, Hanning CD, Langeron O, Johnson T, Lauven PM, Kristensen PA, Biedler A, van Beem H, Fraidakis O, Silverstein JH, Beneken JE, Gravenstein JS. (1998) Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. Mar 351 (9106) 857–61.

25.

Johnson T, Monk T, Rasmussen LS, Abildstrom H, Houx P, Korttila K, Kuipers HM, Hanning CD, Siersma VD, Kristensen D, Canet J, Ibañaz MT, Moller JT. Postoperative cognitive dysfunction in middle-aged patients. Anesthesiology. 2002;96(6):1351–7.PubMedCrossRef

26.

Culley DJ, Flaherty D, Fahey MC, Rudolph JL, Javedan H, Huang CC, Wright J, Bader AM, Hyman BT, Blacker D, Crosby G. Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients. Anesthesiology. 2017;127(5):765–74.PubMedCrossRef

27.

Silbert B, Evered L, Scott DA, McMahon S, Choong P, Ames D, Maruff P, Jamrozik K. Preexisting cognitive impairment is associated with postoperative cognitive dysfunction after hip joint replacement surgery. Anesthesiology. 2015;122(6):1224–34.PubMedCrossRef

28.

Zietlow K, McDonald SR, Sloane R, Browndyke J, Lagoo-Deenadayalan S, Heflin MT. Preoperative cognitive impairment as a predictor of postoperative outcomes in a collaborative care model. J Am Geriatr Soc. 2018;66(3):584–9.PubMedPubMedCentralCrossRef

29.

Evered LA, Silbert BS, Scott DA, Maruff P, Ames D. Prevalence of dementia 7.5 years after coronary artery bypass graft surgery. Anesthesiology. 2016;125(1):62–71.PubMedCrossRef

30.

Vidal JS, Sigurdsson S, Jonsdottir MK, Eiriksdottir G, Thorgeirsson G, Kjartansson O, Garcia ME, van Buchem MA, Harris TB, Gudnason V, Launer LJ. Coronary artery calcium, brain function and structure: the AGES-Reykjavik study. Stroke. 2010;41(5):891–7.PubMedPubMedCentralCrossRef

31.

Sabayan B, van Buchem MA, Sigurdsson S, Zhang Q, Harris TB, Gudnason V, Arai AE, Launer LJ. Cardiac hemodynamics are linked with structural and functional features of brain aging: the age, gene/environment susceptibility (AGES)-Reykjavik study. J Am Heart Assoc. 2015;4(1): e001294.PubMedPubMedCentralCrossRef

32.

Ito A, Goto T, Maekawa K, Baba T, Mishima Y, Ushijima K. Postoperative neurological complications and risk factors for pre-existing silent brain infarction in elderly patients undergoing coronary artery bypass grafting. J Anesth. 2012;26(3):405–11.PubMedCrossRef

33.

DeCarli C, Massaro J, Harvey D, Hald J, Tullberg M, Au R, Beiser A, D’Agostino R, Wolf PA. Measures of brain morphology and infarction in the framingham heart study: establishing what is normal. Neurobiol Aging. 2005;26(4):491–510.PubMedCrossRef

34.

Smith EE, O’Donnell M, Dagenais G, Lear SA, Wielgosz A, Sharma M, Poirier P, Stotts G, Black SE, Strother S, Noseworthy MD, Benavente O, Modi J, Goyal M, Batool S, Sanchez K, Hill V, McCreary CR, Frayne R, Islam S, DeJesus J, Rangarajan S, Teo K, Yusuf S. Early cerebral small vessel disease and brain volume cognition and gait. Ann Neurol. 2015;77(2):251–61.PubMedPubMedCentralCrossRef

35.

Tini G, Scagliola R, Monacelli F, Malfa GL, Porto I, Brunelli C, Rosa GM. Alzheimer’s disease and cardiovascular disease: a particular association. Cardiol Res Pract. 2020;2020:2617970.PubMedPubMedCentralCrossRef

36.

Kuźma E, Airdrie J, Littlejohns TJ, Lourida I, Thompson-Coon J, Lang IA, Scrobotovici M, Thacker EL, Fitzpatrick A, Kuller LH, Lopez OL, Longstreth WT Jr, Ukoumunne OC, Llewellyn DJ. Coronary artery bypass graft surgery and dementia risk in the cardiovascular health study. Alzheimer Dis Assoc Disord. 2017;31(2):120–7.PubMedPubMedCentralCrossRef

37.

Dokkedal U, Hansen TG, Rasmussen LS, Mengel-From J, Christensen K. Cognitive functioning after surgery in middle-aged and elderly Danish twins. Anesthesiology. 2016;124(2):312–21.PubMedCrossRef

38.

Bratzke LC, Koscik RL, Schenning KJ, et al. Cognitive decline in the middle-aged after surgery and anaesthesia: results from the wisconsin registry for Alzheimer’s prevention cohort. Anaesthesia. 2018;73(5):549–55.PubMedPubMedCentralCrossRef

Title: Predictors of early postoperative cognitive dysfunction in middle-aged patients undergoing cardiac surgery: retrospective observational study
Authors: Takafumi Oyoshi
Kengo Maekawa
Yuki Mitsuta
Naoyuki Hirata
Publication date: 20-01-2023
Publisher: Springer Nature Singapore
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Heart Surgery
MR Angiography
Heart Surgery
Mild Neurocognitive Disorder
Published in: Journal of Anesthesia / Issue 3/2023
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI: https://doi.org/10.1007/s00540-023-03164-w

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Springer Medicine

Predictors of early postoperative cognitive dysfunction in middle-aged patients undergoing cardiac surgery: retrospective observational study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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