Abstract
ObjectivesPostoperative cognitive dysfunction (POCD) is a common consequence of coronary artery bypass grafting. However, domain‐specific associations between postoperative changes and long‐term performance are poorly known. The aim of this study was to investigate whether domain‐specific cognitive changes after cardiac surgery predict long‐term cognitive outcome.Materials and MethodsWe assessed 100 patients (86 men, mean age 60) before coronary artery bypass grafting, with re‐examinations after one week, three months, and a mean of 6.7 years. The extensive neuropsychological test battery was organized into seven functional cognitive domains. Cognitive decline and improvement were defined with the reliable change index derived from 17 matching healthy controls. Analyses were adjusted for baseline cognitive performance, age, gender, education and cardiovascular risks factors.ResultsOn group level, one week after surgery 71% patients showed cognitive decline and 9% improvement in any functional domain, as compared to preoperative results. Three months postsurgery, decline was observed in 47% and improvement in 25% of patients. Executive functioning was the most sensitive domain to both decline and improvement. Postoperative dysfunction predicted long‐term cognitive deterioration six years after operation, particularly in the domain of executive functioning.ConclusionsPOCD after coronary artery bypass grafting is an essential risk factor for long‐term deterioration and an indication for neuropsychological follow‐up. Assessment of change in executive functioning after coronary artery bypass grafting may help to identify patients at risk for unfavorable long‐term outcome.
Highlights
Cognitive decline after coronary artery bypass grafting (CABG) has received a great deal of attention during the last few decades
The present study aimed to investigate the incidence of domain-specific cognitive decline and improvement after CABG and their association with long-term cognitive outcome
The patients of the long-term follow-up were slightly younger than dropouts, but there were no differences in gender, education, occupation, surgery-related factors, cardiovascular risk factors, domainwise postoperative cognitive dysfunction (POCD) occurrence, or baseline Mini-Mental State Examination (MMSE) score between late follow-up patients and dropouts
Summary
Cognitive decline after coronary artery bypass grafting (CABG) has received a great deal of attention during the last few decades. In a more recent controlled study, a decline of reliable change index score exceeding 1.96 in at least two individual tests or in a composite score at three and 12 months was related to the occurrence of a defined decline after a follow-up time of 7.5 years (Evered et al, 2016). Studies addressing cognitive improvement after CABG are scarce, and research on domainwise improvement is lacking To date, it is not known which cognitive functions have most prognostic value on long-term cognitive outcome. The present study aimed to investigate the incidence of domain-specific cognitive decline and improvement after CABG and their association with long-term cognitive outcome
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