Structure of cognitive disorders and predictors of their occurrence in patients after cardiac surgery

Abstract

Objective — to determine the presence and severity of moderate cognitive disorders (CD) in patients before and after cardiac surgery in the early postoperative period
 Methods and subjects. 56 patients were examined, including 19 (33.9 %) men and 37 (66,1 %) women , mean age 60.86 ± 8.86. Cardiac surgery was performed for ischemic heart disease in 37 (66.1 %) patients, for valvular heart disease — in 19 (33.9 %, p = 0.02). Assessment of cognitive functions was performed before surgery, on the 3rd and 7th day of the postoperative period using the Montreal Cognitive Test.
 Results. Before surgery, most patients (75.0 %) had mild CRs, 5.4 % had moderate CRs (p <0.01), and 19.6 % had no CRs (p = 0.02). In general, the distribution by the severity of CR in the early postoperative period did not differ from that before surgery, but there were patients with severe CR (3.6 and 1.8 %, respectively, on the 3rd and 7th days, p = 0.05) ...In the structure of CD, on the 3rd day of the postoperative period, there was a significant decrease in visually constructive skills (4.07 versus 3.7; p < 0.001), a deterioration in the ability to consistently calculate (2.66 versus 2.45; p = 0.02), repetition phrases (1.16 versus 1.0; p = 0.02). On the 7th day of the postoperative period, there was a significant decrease in verbal speed (0.48 versus 0.32; p = 0.006) and an improvement in memory (1.79 versus 2.29; p = 0.01). Probable predictors of the onset of cognitive disorders in the early postoperative period are: a history of stroke — r = –0.282; p = 0.04. There was a correlation with the presence of atherosclerotic lesions of the coronary arteries according to coronary angiography (r = –0.259; p = 0.05), surgery performed under cardiopulmonary bypass (r = 0.29; p = 0.03), and a tendency towards statistical significance of correlation with the presence of signs of dyslipidemia according to lipid profile data (r = –0.227; p = 0.09).
 Conclusions. It was found that 75 % of patients had mild CR before surgery. The distribution according to the severity of CR in the early postoperative period differed from that before surgery by the appearance of patients with severe CR. In the CR structure, on the 3rd day of the postoperative period, a statistically significant decrease in visual‑constructive skills, a deterioration in the ability to consistently calculate and repeat a phrase were observed. On the 7th day, a statistically significant decrease in verbal speed and an improvement in memory were noted. Probable predictors of CR in the early postoperative period are a history of acute cerebrovascular accident, atherosclerotic lesion of the coronary arteries according to coronary angiography, surgery performed under cardiopulmonary bypass, the presence of signs of dyslipidemia according to lipid profile data.