Structured abstract
Question
In patients undergoing elective coronary artery bypass grafting (CABG) with cardiopulmonary bypass, what is the effect of perioperative neurocognitive decline on long-term neurocognitive function?
Design
Prospective cohort followed for five years.
Setting
Single academic centre.
Patients
Two hundred and sixty-one adult patients undergoing elective CABG were enrolled. Patients with symptomatic cerebrovascular disease, psychiatric illness, renal disease, active liver disease, less than seventh grade education, or inability to read were excluded.
Assessment of prognostic factors
Predictors of longterm cognitive decline were determined by multivariate logistic and linear regression methods.
Main outcomes
Overall neurocognitive function and frequency of cognitive decline were the main outcomes. Overall cognitive function was assessed using a composite cognitive index (CCI) score representing the sum of scores of four neurocognitive domains (verbal memory and language comprehension; abstraction and visuospatial orientation; attention, psychomotor speed, and concentration; visual memory). Cognitive decline was defined as a decrease, compared to baseline, of one standard deviation in performance in any of the domains. Domains were derived by factor analysis of test results from nine neurocognitive tests. All tests were administered before surgery (baseline), one day before discharge, and six weeks, six months, and five years post-CABG. The study took place from March 1989 to November 1998.
Main results
By the end of the study, 172 patients had completed five years of follow-up, 23 had died, 14 could not continue due to health problems, and 52 were lost to follow-up. Frequency of cognitive decline was 53% at discharge, 36% at six weeks, 24% at six months, and 42% at five years. CCI scores (means ± SD; positive value = improvement, negative value = decline) were −0.36 ± 2.05 at discharge, 0.99 ± 2.03 at six weeks, 1.37 ± 2.11 at six months, and −1.45 ± 4.09 at five years. Older age, lower level of education, and cognitive decline at time of discharge predicted long-term cognitive decline at five years.
Conclusion
There is a high prevalence of cognitive decline after CABG. Cognitive decline at time of discharge predicts later cognitive decline at five years.
Funding
National Institutes of Health and the American Heart Association.
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Murkin, J., Hall, R. Best evidence in anesthetic practice Prognosis: cognitive function at hospital discharge predicts long-term cognitive function after coronary artery bypass surgery. Can J Anesth 49, 497–499 (2002). https://doi.org/10.1007/BF03017929
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DOI: https://doi.org/10.1007/BF03017929