Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Behavioral Medicine
Published in: Annals of Behavioral Medicine 4/2016

Open Access 01-08-2016 | Original Article

Pre-Operative Cognitive Functioning and Inflammatory and Neuroendocrine Responses to Cardiac Surgery

Authors: Lydia Poole, PhD, Amy Ronaldson, MSc, Tara Kidd, PhD, Elizabeth Leigh, PhD, Marjan Jahangiri, FRCS CTh, Andrew Steptoe, DSc

Published in: Annals of Behavioral Medicine | Issue 4/2016

Login to get access

Abstract

Background

Cognitive functioning is linked to cardiac mortality and morbidity, but the mechanisms underlying this relationship are unclear.

Purpose

To examine the relationship between pre-operative cognitive functioning and post-operative inflammatory and neuroendocrine responses in patients undergoing coronary artery bypass graft (CABG) surgery.

Methods

One-hundred ninety-three outpatients were screened to assess their cognitive function using the Montreal Cognitive Assessment (MoCA) on average 30 days prior to CABG surgery and provided blood samples for the measurement of interleukin (IL)-6 and C-reactive protein (CRP) and saliva samples for the measurement of diurnal cortisol. Participants were followed-up 4–8 days following surgery for the repeat measurement of IL-6 and CRP and 60 days after surgery for the measurement of diurnal salivary cortisol.

Results

Patients with low cognitive function (MoCA < 26) prior to surgery reached higher IL-6 concentrations in the days after surgery (β = −0.212, p = 0.021) and had greater cortisol output across the day 2 months after surgery (β = −0.179, p = 0.044).

Conclusions

Low cognitive functioning is associated with a more negative pattern of biological response to surgery, indicative of poorer physical recovery. These pathways may contribute to the links between cognitive function and cardiovascular pathology.
Literature
1.
Qiu C, Fratiglioni L. A major role for cardiovascular burden in age-related cognitive decline. Nat Rev Cardiol. 2015; 12(5): 267-277.CrossRefPubMed
2.
Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke J Cereb Circ. 2011; 42(9): 2672-2713.CrossRef
3.
Bosworth HB, Siegler IC. Terminal change in cognitive function: an updated review of longitudinal studies. Exp Aging Res. 2002; 28(3): 299-315.CrossRefPubMed
4.
Batterham PJ, Mackinnon AJ, Christensen H. The association between change in cognitive ability and cause-specific mortality in a community sample of older adults. Psychol Aging. 2012; 27(1): 229-236.CrossRefPubMed
5.
Silbert BS, Scott DA, Evered LA, Lewis MS, Maruff PT. Preexisting cognitive impairment in patients scheduled for elective coronary artery bypass graft surgery. Anesth Analg. 2007; 104(5): 1023-1028.CrossRefPubMed
6.
van Dijk D, Keizer AM, Diephuis JC, et al. Neurocognitive dysfunction after coronary artery bypass surgery: a systematic review. J Thorac Cardiovasc Surg. 2000; 120(4): 632-639.CrossRefPubMed
7.
Newman MF, Kirchner JL, Phillips-Bute B, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001; 344(6): 395-402.CrossRefPubMed
8.
Yousuf O, Mohanty BD, Martin SS, et al. High-sensitivity C-reactive protein and cardiovascular disease: a resolute belief or an elusive link? J Am Coll Cardiol. 2013; 62(5): 397-408.CrossRefPubMed
9.
Kaptoge S, Seshasai SRK, Gao P, et al. Inflammatory cytokines and risk of coronary heart disease: new prospective study and updated meta-analysis. Eur Heart J. 2014; 35(9): 578-589.CrossRefPubMed
10.
Beeri MS, Ravona-Springer R, Silverman JM, Haroutunian V. The effects of cardiovascular risk factors on cognitive compromise. Dialogues Clin Neurosci. 2009; 11(2): 201-212.PubMedPubMedCentral
11.
Biglioli P, Cannata A, Alamanni F, et al. Biological effects of off-pump vs. on-pump coronary artery surgery: focus on inflammation, hemostasis and oxidative stress. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2003; 24(2): 260-269.CrossRef
12.
Levy JH, Tanaka KA. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 2003; 75(2): S715-S720.CrossRefPubMed
13.
Roberts RO, Geda YE, Knopman DS, et al. Association of C-reactive protein with mild cognitive impairment. Alzheimers Dement J Alzheimers Assoc. 2009; 5(5): 398-405.CrossRef
14.
Tilvis RS, Kähönen-Väre MH, Jolkkonen J, et al. Predictors of cognitive decline and mortality of aged people over a 10-year period. J Gerontol A Biol Sci Med Sci. 2004; 59(3): 268-274.CrossRefPubMed
15.
Weaver JD, Huang M-H, Albert M, et al. Interleukin-6 and risk of cognitive decline: MacArthur studies of successful aging. Neurology. 2002; 59(3): 371-378.CrossRefPubMed
16.
Yaffe K, Lindquist K, Penninx BW, et al. Inflammatory markers and cognition in well-functioning African-American and white elders. Neurology. 2003; 61(1): 76-80.CrossRefPubMed
17.
Dik MG, Jonker C, Hack CE, et al. Serum inflammatory proteins and cognitive decline in older persons. Neurology. 2005; 64(8): 1371-1377.CrossRefPubMed
18.
Brown ES, Varghese FP, McEwen BS. Association of depression with medical illness: does cortisol play a role? Biol Psychiatry. 2004; 55(1): 1-9.CrossRefPubMed
19.
Hackett RA, Steptoe A, Kumari M. Association of diurnal patterns in salivary cortisol with type 2 diabetes in the Whitehall II study. J Clin Endocrinol Metab. 2014; 99(12): 4625-4631.CrossRefPubMedPubMedCentral
20.
Otte C, Marmar CR, Pipkin SS, et al. Depression and 24-hour urinary cortisol in medical outpatients with coronary heart disease: the heart and soul study. Biol Psychiatry. 2004; 56(4): 241-247.CrossRefPubMedPubMedCentral
21.
Roth-Isigkeit AK, Schmucker P. Postoperative dissociation of blood levels of cortisol and adrenocorticotropin after coronary artery bypass grafting surgery. Steroids. 1997; 62(11): 695-699.CrossRefPubMed
22.
Tønnesen E, Brinkløv MM, Christensen NJ, Olesen AS, Madsen T. Natural killer cell activity and lymphocyte function during and after coronary artery bypass grafting in relation to the endocrine stress response. Anesthesiology. 1987; 67(4): 526-533.CrossRefPubMed
23.
Lupien SJ, Fiocco A, Wan N, et al. Stress hormones and human memory function across the lifespan. Psychoneuroendocrinology. 2005; 30(3): 225-242.CrossRefPubMed
24.
Lee BK, Glass TA, McAtee MJ, et al. Associations of salivary cortisol with cognitive function in the Baltimore memory study. Arch Gen Psychiatry. 2007; 64(7): 810-818.CrossRefPubMed
25.
Venero C, Díaz-Mardomingo C, Pereda-Pérez I, et al. Increased morning salivary cortisol levels in older adults with nonamnestic and multidomain mild cognitive impairment. Psychoneuroendocrinology. 2013; 38(4): 488-498.CrossRefPubMed
26.
Beluche I, Carrière I, Ritchie K, Ancelin ML. A prospective study of diurnal cortisol and cognitive function in community-dwelling elderly people. Psychol Med. 2010; 40(6): 1039-1049.CrossRefPubMed
27.
Mu D-L, Li L-H, Wang D-X, et al. High postoperative serum cortisol level is associated with increased risk of cognitive dysfunction early after coronary artery bypass graft surgery: a prospective cohort study. PLoS ONE. 2013; 8(10), e77637.CrossRefPubMedPubMedCentral
28.
Poole L, Kidd T, Leigh E, et al. Preoperative sleep complaints are associated with poor physical recovery in the months following cardiac surgery. Ann Behav Med Publ Soc Behav Med. 2013; 47(3): 347-357.CrossRef
29.
Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53(4): 695-699.CrossRefPubMed
30.
Chida Y, Steptoe A. Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biol Psychol. 2009; 80(3): 265-278.CrossRefPubMed
31.
Dockray S, Bhattacharyya MR, Molloy GJ, Steptoe A. The cortisol awakening response in relation to objective and subjective measures of waking in the morning. Psychoneuroendocrinology. 2008; 33(1): 77-82.CrossRefPubMed
32.
Pruessner JC, Kirschbaum C, Meinlschmid G, Hellhammer DH. Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology. 2003; 28(7): 916-931.CrossRefPubMed
33.
Messerli-Bürgy N, Molloy GJ, Wikman A, et al. Cortisol levels and history of depression in acute coronary syndrome patients. Psychol Med. 2012; 11: 1-9.
34.
Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988; 8(1): 77-100.CrossRef
35.
Roques F, Michel P, Goldstone AR, Nashef SAM. The logistic EuroSCORE. Eur Heart J. 2003; 24(9): 881-882.CrossRefPubMed
36.
Czerny M, Baumer H, Kilo J, et al. Inflammatory response and myocardial injury following coronary artery bypass grafting with or without cardiopulmonary bypass. Eur J Cardiothorac Surg. 2000; 17(6): 737-742.CrossRefPubMed
37.
Wan S, Marchant A, DeSmet J-M, et al. Human cytokine responses to cardiac transplantation and coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1996; 111(2): 469-477.CrossRefPubMed
38.
He L, Tang X, Ling W, Chen W, Chen Y. Early C-reactive protein in the prediction of long-term outcomes after acute coronary syndromes: a meta-analysis of longitudinal studies. Heart Br Cardiac Soc. 2010; 96(5): 339-346.CrossRef
39.
Biasucci LM, Liuzzo G, Fantuzzi G, et al. Increasing levels of interleukin (IL)-1Ra and IL-6 during the first 2 days of hospitalization in unstable angina are associated with increased risk of in-hospital coronary events. Circulation. 1999; 99(16): 2079-2084.CrossRefPubMed
40.
Wu N, Xu B, Xiang Y, et al. Association of inflammatory factors with occurrence and recurrence of atrial fibrillation: a meta-analysis. Int J Cardiol. 2013; 169(1): 62-72.CrossRefPubMed
41.
Roncada G, Dendale P, Linsen L, Hendrikx M, Hansen D. Reduction in pulmonary function after CABG surgery is related to postoperative inflammation and hypercortisolemia. Int J Clin Exp Med. 2015; 8(7): 10938-10946.PubMedPubMedCentral
42.
De Lorenzo A, Pittella F, Rocha A. Increased preoperative C-reactive protein levels are associated with inhospital death after coronary artery bypass surgery. Inflammation. 2012; 35(3): 1179-1183.CrossRefPubMed
43.
Steptoe A, Poole L, Ronaldson A, et al. Depression 1 year after CABG is predicted by acute inflammatory responses. J Am Coll Cardiol. 2015; 65(16): 1710-1711.CrossRefPubMed
44.
Poole L, Kidd T, Leigh E, et al. Depression, C-reactive protein and length of post-operative hospital stay in coronary artery bypass graft surgery patients. Brain Behav Immun. 2013; 37: 115-121.CrossRefPubMed
45.
Lupien SJ, Nair NP, Brière S, et al. Increased cortisol levels and impaired cognition in human aging: implication for depression and dementia in later life. Rev Neurosci. 1999; 10(2): 117-139.PubMed
46.
Herbert J, Goodyer IM, Grossman AB, et al. Do corticosteroids damage the brain? J Neuroendocrinol. 2006; 18(6): 393-411.CrossRefPubMed
47.
48.
Rasmussen LS, O’Brien JT, Silverstein JH, et al. Is peri-operative cortisol secretion related to post-operative cognitive dysfunction? Acta Anaesthesiol Scand. 2005; 49(9): 1225-1231.CrossRefPubMed
49.
Mu D-L, Wang D-X, Li L-H, et al. High serum cortisol level is associated with increased risk of delirium after coronary artery bypass graft surgery: a prospective cohort study. Crit Care Lond Engl. 2010; 14(6): R238.CrossRef
50.
Ronaldson A, Kidd T, Poole L, et al. Diurnal cortisol rhythm is associated with adverse cardiac events and mortality in coronary artery bypass patients. J Clin Endocrinol Metab. 2015; 100(10): 3676-3682.CrossRefPubMedPubMedCentral
51.
Hellhammer J, Fries E, Schweisthal OW, et al. Several daily measurements are necessary to reliably assess the cortisol rise after awakening: state and trait components. Psychoneuroendocrinology. 2007; 32(1): 80-86.CrossRefPubMed
52.
McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998; 338(3): 171-179.CrossRefPubMed
Metadata
Title
Pre-Operative Cognitive Functioning and Inflammatory and Neuroendocrine Responses to Cardiac Surgery
Authors
Lydia Poole, PhD
Amy Ronaldson, MSc
Tara Kidd, PhD
Elizabeth Leigh, PhD
Marjan Jahangiri, FRCS CTh
Andrew Steptoe, DSc
Publication date
01-08-2016
Publisher
Springer US
Published in
Annals of Behavioral Medicine / Issue 4/2016
Print ISSN: 0883-6612
Electronic ISSN: 1532-4796
DOI
https://doi.org/10.1007/s12160-016-9779-7

Other articles of this Issue 4/2016

Annals of Behavioral Medicine 4/2016 Go to the issue

Brief Report

Unintended Effects of a Smoking Cessation Intervention on Latino Fathers’ Binge Drinking In Early Postpartum

Original Article

Mind the Gap? An Intensive Longitudinal Study of Between-Person and Within-Person Intention-Behavior Relations

Original Article

A Role for Behavior in the Relationships Between Depression and Hostility and Cardiovascular Disease Incidence, Mortality, and All-Cause Mortality: the Prime Study

Original Article

An Ethogram to Quantify Operating Room Behavior

Original Article

Do Anxiety Disorders Play a Role in Adolescent Obesity?

Original Article

Post-menopausal Women Exhibit Greater Interleukin-6 Responses to Mental Stress Than Older Men