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Lu N, Chi Y, Liu M. Relationship Between Coronary Artery Revascularization and Postoperative Delirium: Progress and Perspectives. Angiology 2024:33197241252467. [PMID: 38712998 DOI: 10.1177/00033197241252467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Brain dysfunction resulting from damage to the heart-brain link leads to a decline in cognitive function. This, in turn, gives rise to the clinical symptom of perioperative delirium in patients undergoing coronary artery revascularization. Those affected are provided symptomatic treatment, but many do not recover fully. Thus, medium- and long-term mortality and adverse event rates remain relatively high in patients with perioperative delirium. Despite the relatively high incidence of perioperative delirium in patients undergoing coronary artery revascularization, it has not been systematically investigated. Inflammation, vascular damage, neuronal damage, and embolism are all involved in the injury process. Here, we discuss the incidence rate, pathological mechanisms, and prognosis of delirium after coronary artery revascularization. We also discuss in detail the risk factors for delirium after coronary artery revascularization, such as anxiety, depression, mode of operation, and drug use. We hope that prevention, early diagnosis, assessment, and potential treatment can be achieved by cardiologists to improve patient prognosis.
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Affiliation(s)
- Nan Lu
- Department of Psycho-cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Yunpeng Chi
- Department of Psycho-cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Meiyan Liu
- Department of Psycho-cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Chang H, Chen E, Zhu T, Liu J, Chen C. Communication Regarding the Myocardial Ischemia/Reperfusion and Cognitive Impairment: A Narrative Literature Review. J Alzheimers Dis 2024; 97:1545-1570. [PMID: 38277294 PMCID: PMC10894588 DOI: 10.3233/jad-230886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/28/2024]
Abstract
Coronary artery disease is a prevalent ischemic disease that results in insufficient blood supply to the heart muscle due to narrowing or occlusion of the coronary arteries. Various reperfusion strategies, including pharmacological thrombolysis and percutaneous coronary intervention, have been developed to enhance blood flow restoration. However, these interventions can lead to myocardial ischemia/reperfusion injury (MI/RI), which can cause unpredictable complications. Recent research has highlighted a compelling association between MI/RI and cognitive function, revealing pathophysiological mechanisms that may explain altered brain cognition. Manifestations in the brain following MI/RI exhibit pathological features resembling those observed in Alzheimer's disease (AD), implying a potential link between MI/RI and the development of AD. The pro-inflammatory state following MI/RI may induce neuroinflammation via systemic inflammation, while impaired cardiac function can result in cerebral under-perfusion. This review delves into the role of extracellular vesicles in transporting deleterious substances from the heart to the brain during conditions of MI/RI, potentially contributing to impaired cognition. Addressing the cognitive consequence of MI/RI, the review also emphasizes potential neuroprotective interventions and pharmacological treatments within the MI/RI model. In conclusion, the review underscores the significant impact of MI/RI on cognitive function, summarizes potential mechanisms of cardio-cerebral communication in the context of MI/RI, and offers ideas and insights for the prevention and treatment of cognitive dysfunction following MI/RI.
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Affiliation(s)
- Haiqing Chang
- Department of Anesthesiology, West China Hospital, Sichuan University, Sichuan, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Erya Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Sichuan, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Sichuan, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Sichuan, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chan Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Sichuan, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Althukair WT, Nuhmani S. Effect of different coronary artery revascularization procedures on cognition: A systematic review. Heliyon 2023; 9:e19735. [PMID: 37810024 PMCID: PMC10558982 DOI: 10.1016/j.heliyon.2023.e19735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Coronary revascularization interventions have been associated with post-intervention cognitive decline. Hence, this systematic review aims to compare the long-term effects of different coronary revascularization interventions on cognition. The Cochrane Library and MEDLINE databases were searched for articles published between January 2009 and January 2023. Articles on clinical trials and cohort studies that compared at least two different interventions with a minimum three months follow up were included to evaluate the consequences of different intervention techniques on cognition. Each selected study was evaluated using a revised tool to assess the risk of bias in randomized trials (RoB 2), and Risk of Bias In Non-Randomized Studies - of Interventions(ROBINS-1) was used for evaluating non-randomized studies. Five eligible studies, with four different comparisons, were included. Out of these studies, three RCTs and two cohort studies were included A participants gone through different procedures; on-pump and off-pump coronary artery bypass grafting (CABG), Percutaneous coronary intervention (PCI conventional cardiopulmonary bypass (CCPB), the miniaturized cardiopulmonary bypass (MCPB) and endoscopic coronary artery bypass grafting (Endo-CABG). These comparisons showed that different interventions have different effects on cognition; however, there is no solid evidence of correlations between them. Thus, the results of this review suggest that there should be greater focus on comparing interventions and that a reasonable follow-up duration should be set to avoid the influence of confounders. There is also a need to determine the effect of long-term cognitive decline while reducing interference by other variables.
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Affiliation(s)
- Wadha Tareq Althukair
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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Affiliation(s)
- Michael S. Avidan
- Department of Anesthesiology, Washington University School
of Medicine
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Lappalainen L, Rajamaki B, Tolppanen AM, Hartikainen S. Coronary artery revascularizations and cognitive decline - A systematic review. Curr Probl Cardiol 2021; 47:100960. [PMID: 34363848 DOI: 10.1016/j.cpcardiol.2021.100960] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 12/19/2022]
Abstract
Coronary artery disease (CAD) is a risk factor for cognitive decline. The aim of this study was to systematically review recent literature on whether coronary artery revascularizations are associated to cognitive decline and dementia. Pubmed, Scopus, and CINAHL (EBSCO) were searched systematically from January 2009 till September 2020. Studies were conducted on persons with CAD undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) procedure compared to other coronary artery disease treatments, and the outcome was cognitive decline or dementia. Altogether four of the 680 reviewed articles met inclusion criteria. Results were inconsistent, and the outcome measurements heterogeneous between studies. Our findings indicate an evidence gap in the current understanding of long-term outcomes following coronary artery revascularization. However, evidence of long-term effects on cognition would complement our understanding of their benefits. There is a need for more studies on long-term cognitive outcomes after coronary artery revascularizations.
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Affiliation(s)
- Laura Lappalainen
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
| | - Blair Rajamaki
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
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Kannampallil T, Holzer KJ, Abraham J, Naim U, Lenze EJ, Haroutounian S, Avidan MS. Surgical Complications in Older Adults Predict Decline in Self-Perceived Cognitive Function in the Ensuing Year: A Cohort Study. Am J Geriatr Psychiatry 2021; 29:352-361. [PMID: 32981851 DOI: 10.1016/j.jagp.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgical complications are common among older adults and are potential indicators of poorer long-term outcomes. The authors examined the effects of in-hospital complications on changes in older adults' self-perceived cognitive function in the year after surgery. METHOD The authors conducted a prospective longitudinal study with 2,155 older adults (age ≥ 65) undergoing surgery, investigating the association between self-reported, in-hospital complications after surgery and Patient-Reported Outcomes Measurement Information System Applied Cognition-Abilities survey (4 items, cognitive function) at 30 days and 1 year after surgery. Surveys were scored on a continuous scale of 0-100, with higher scores representing better self-perceived cognitive functioning. Patient characteristics including demographics, type of complications, surgery type, pain, and activities of daily living were also collected. RESULTS Having one in-hospital complication was associated with a decrease of 1.79 points (95% confidence interval (CI): -2.78, -0.80), indicating lower self-perceived cognitive functioning at 1 year after surgery; having two or more in-hospital complications was associated with 2.82 point (95% CI: -4.50, -1.15) decrease at 1 year after surgery. Models specific to complication type indicated that respiratory [-3.04, (95% CI: -5.50, -0.57)], neural [-2.11, (95% CI: -3.97, -0.25)], and general complications [-2.39, (95% CI: -3.51, -1.28)] were associated with statistically significant decreases in cognitive function. DISCUSSION Older surgical patients who suffer in-hospital complications show greater decline in self-perceived cognitive function during the ensuing year. Geriatric specialists may be able to intervene in the immediate perioperative period to reduce complications and possibly mitigate cognitive decline among older adults.
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Affiliation(s)
- Thomas Kannampallil
- Department of Anesthesiology (TK, KJH, JA, UN, SH, MSA), Washington University School of Medicine, St Louis, MO; Institute for Informatics (TK, JA), Washington University School of Medicine, St Louis, MO.
| | - Katherine J Holzer
- Department of Anesthesiology (TK, KJH, JA, UN, SH, MSA), Washington University School of Medicine, St Louis, MO
| | - Joanna Abraham
- Department of Anesthesiology (TK, KJH, JA, UN, SH, MSA), Washington University School of Medicine, St Louis, MO; Institute for Informatics (TK, JA), Washington University School of Medicine, St Louis, MO
| | - Uzma Naim
- Department of Anesthesiology (TK, KJH, JA, UN, SH, MSA), Washington University School of Medicine, St Louis, MO
| | - Eric J Lenze
- Department of Psychiatry (EJL), Washington University School of Medicine, St Louis, MO
| | - Simon Haroutounian
- Department of Anesthesiology (TK, KJH, JA, UN, SH, MSA), Washington University School of Medicine, St Louis, MO
| | - Michael S Avidan
- Department of Anesthesiology (TK, KJH, JA, UN, SH, MSA), Washington University School of Medicine, St Louis, MO
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Relander K, Hietanen M, Rantanen K, Rämö J, Vento A, Saastamoinen KP, Roine RO, Soinne L. Postoperative cognitive change after cardiac surgery predicts long-term cognitive outcome. Brain Behav 2020; 10:e01750. [PMID: 32681544 PMCID: PMC7507551 DOI: 10.1002/brb3.1750] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Postoperative 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 METHODS We 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. RESULTS On 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. CONCLUSIONS POCD 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.
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Affiliation(s)
- Kristiina Relander
- Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Rantanen
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juhani Rämö
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Vento
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kari-Pekka Saastamoinen
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto O Roine
- University of Turku and Turku University Hospital, Turku, Finland
| | - Lauri Soinne
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Whitlock EL, Grisell Diaz-Ramirez L, Avidan MS. Surgery and persistent cognitive decline: a commentary and an independent discussion. Br J Anaesth 2019; 124:229-234. [PMID: 31839254 DOI: 10.1016/j.bja.2019.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Elizabeth L Whitlock
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - L Grisell Diaz-Ramirez
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
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Krause BM, Sabia S, Manning HJ, Singh-Manoux A, Sanders RD. Association between major surgical admissions and the cognitive trajectory: 19 year follow-up of Whitehall II cohort study. BMJ 2019; 366:l4466. [PMID: 31391161 PMCID: PMC6683971 DOI: 10.1136/bmj.l4466] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To quantify the association between major surgery and the age related cognitive trajectory. DESIGN Prospective longitudinal cohort study. SETTING United Kingdom. PARTICIPANTS 7532 adults with as many as five cognitive assessments between 1997 and 2016 in the Whitehall II study, with linkage to hospital episode statistics. Exposures of interest included any major hospital admission, defined as requiring more than one overnight stay during follow-up. MAIN OUTCOMES MEASURES The primary outcome was the global cognitive score established from a battery of cognitive tests encompassing reasoning, memory, and phonemic and semantic fluency. Bayesian linear mixed effects models were used to calculate the change in the age related cognitive trajectory after hospital admission. The odds of substantial cognitive decline induced by surgery defined as more than 1.96 standard deviations from a predicted trajectory (based on the first three cognitive waves of data) was also calculated. RESULTS After accounting for the age related cognitive trajectory, major surgery was associated with a small additional cognitive decline, equivalent on average to less than five months of aging (95% credible interval 0.01 to 0.73 years). In comparison, admissions for medical conditions and stroke were associated with 1.4 (1.0 to 1.8) and 13 (9.6 to 16) years of aging, respectively. Substantial cognitive decline occurred in 2.5% of participants with no admissions, 5.5% of surgical admissions, and 12.7% of medical admissions. Compared with participants with no major hospital admissions, those with surgical or medical events were more likely to have substantial decline from their predicted trajectory (surgical admissions odds ratio 2.3, 95% credible interval 1.4 to 3.9; medical admissions 6.2, 3.4 to 11.0). CONCLUSIONS Major surgery is associated with a small, long term change in the average cognitive trajectory that is less profound than for major medical admissions. The odds of substantial cognitive decline after surgery was about doubled, though lower than for medical admissions. During informed consent, this information should be weighed against the potential health benefits of surgery.
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Affiliation(s)
- Bryan M Krause
- Department of Anesthesiology, University of Wisconsin, Madison, WI 53792-3272, USA
| | - Séverine Sabia
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Helen J Manning
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
| | - Archana Singh-Manoux
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Robert D Sanders
- Department of Anesthesiology, University of Wisconsin, Madison, WI 53792-3272, USA
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Whitlock EL, Diaz-Ramirez LG, Smith AK, Boscardin WJ, Avidan MS, Glymour MM. Cognitive Change After Cardiac Surgery Versus Cardiac Catheterization: A Population-Based Study. Ann Thorac Surg 2018; 107:1119-1125. [PMID: 30578068 DOI: 10.1016/j.athoracsur.2018.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/24/2018] [Accepted: 10/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite concern that cardiac surgery may adversely affect cognition, little evidence is available from population-based studies using presurgery data. With the use of the Health and Retirement Study, we compared memory change after participant-reported cardiac catheterization or cardiac surgery. METHODS Participants were community-dwelling adults aged 65 years and older who self-reported cardiac catheterization or "heart surgery" at any biennial Health and Retirement Study interview between 2000 and 2014. Participants may have undergone the index procedure any time in the preceding 2 years. We modeled preprocedure to postprocedure change in composite memory score, derived from objective memory testing, using linear mixed effects models. We modeled postprocedure subjective memory decline with logistic regression. To quantify clinical relevance, we used the predicted memory change to estimate impact on ability to manage medications and finances independently. RESULTS Of 3,105 participants, 1,921 (62%) underwent catheterization and 1,184 (38%) underwent operation. In adjusted analyses, surgery participants had little difference in preprocedure to postprocedure memory change compared with participants undergoing cardiac catheterization (-0.021 memory units; 95% confidence interval: -0.046 to 0.005 memory units, p = 0.12). If the relationship were causal, the point estimate for memory decline would confer an absolute 0.26% or 0.19% decrease in ability to manage finances or medications, respectively, corresponding to 4.6 additional months of cognitive aging. Cardiac surgery was not associated with subjective memory decline (adjusted odds ratio 0.93, 95% confidence interval: 0.74 to 1.18). CONCLUSIONS In this large, population-based cohort, memory declines after heart surgery and cardiac catheterization were similar. These findings suggest intermediate-term population-level adverse cognitive effects of cardiac surgery, if any, are likely subtle.
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Affiliation(s)
- Elizabeth L Whitlock
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California.
| | - L Grisell Diaz-Ramirez
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California
| | - W John Boscardin
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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Aranake-Chrisinger A, Whitlock EL, Avidan MS. We may be Homo sapiens, but anaesthetists are merely apes when evaluating risk. Br J Anaesth 2018; 121:702-705. [PMID: 30236232 DOI: 10.1016/j.bja.2018.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/11/2018] [Accepted: 07/30/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- A Aranake-Chrisinger
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA.
| | - E L Whitlock
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - M S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
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Vlisides P, Avidan M, Mashour G. Reconceptualising stroke research to inform the question of anaesthetic neurotoxicity. Br J Anaesth 2018; 120:430-435. [DOI: 10.1016/j.bja.2017.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 11/17/2022] Open
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Perceived Cognition after Percutaneous Coronary Intervention: Association with Quality of Life, Mood and Fatigue in the THORESCI Study. Int J Behav Med 2018; 24:552-562. [PMID: 28032322 PMCID: PMC5509816 DOI: 10.1007/s12529-016-9624-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose Percutaneous coronary intervention (PCI) is a common invasive procedure for the treatment of coronary artery diseases. Long-term cognitive functioning after PCI and its association with health-related quality of life (HRQL) and psychological factors is relatively unknown. The aim of this study is to examine whether perceived cognitive functioning during the year after PCI is associated with HRQL over this time period, and whether mood, fatigue, and age are associated with changes in perceived cognition and HRQL. Methods Patients undergoing PCI (n = 384, 79% male, mean age = 63, SD = 10) were recruited in the observational Tilburg Health Outcome Registry of Emotional Stress after Coronary Intervention (THORESCI) cohort study. Perceived concentration and attention problems, HRQL, mood, and fatigue were assessed at baseline, at 1-month and 12-month follow-up. Results General linear mixed modeling analysis showed that across time, between- and within-subject differences in perceived concentration problems were associated with a reduced HRQL in all domains independent of clinical and demographic covariates. Only a part of this association could be explained by negative mood, fatigue, and older age. Similar findings were found for between-subject differences in perceived attention problems. Conclusions Between-subject differences and within-subject changes in perceived cognition in PCI patients were strongly associated with HRQL across time, such that poorer perceived cognition was associated with poorer HRQL, independent of demographic and clinical variables. Most of the associations were also independent of mood and fatigue. The results should increase the awareness of clinicians for the role of cognition in the cardiac rehabilitation and recovery post-PCI.
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Aranake-Chrisinger A, Avidan M. Postoperative delirium portends descent to dementia. Br J Anaesth 2017; 119:285-288. [DOI: 10.1093/bja/aex126] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Anesthesia, brain changes, and behavior: Insights from neural systems biology. Prog Neurobiol 2017; 153:121-160. [PMID: 28189740 DOI: 10.1016/j.pneurobio.2017.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/19/2017] [Accepted: 01/22/2017] [Indexed: 02/08/2023]
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17
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Bhamidipati D, Goldhammer JE, Sperling MR, Torjman MC, McCarey MM, Whellan DJ. Cognitive Outcomes After Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2017; 31:707-718. [DOI: 10.1053/j.jvca.2016.09.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Indexed: 12/17/2022]
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18
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Ottens TH, Hendrikse J, Nathoe HM, Biessels GJ, van Dijk D. Brain volume and cognitive function in patients with revascularized coronary artery disease. Int J Cardiol 2017; 230:80-84. [DOI: 10.1016/j.ijcard.2016.12.079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/18/2016] [Accepted: 12/16/2016] [Indexed: 11/26/2022]
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19
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In Reply. Anesthesiology 2016; 125:428-9. [DOI: 10.1097/aln.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Affiliation(s)
- Michael S. Avidan
- Washington University School of Medicine, Department of
Anesthesiology/Pain Management, 660 South Euclid Avenue, Campus Box 8054, St. Louis,
MO 63110
| | - Alex S. Evers
- Washington University School of Medicine, Department of
Anesthesiology/Pain Management, 660 South Euclid Avenue, Campus Box 8054, St. Louis,
MO 63110
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21
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Cropsey C, Kennedy J, Han J, Pandharipande P. Cognitive Dysfunction, Delirium, and Stroke in Cardiac Surgery Patients. Semin Cardiothorac Vasc Anesth 2015; 19:309-17. [DOI: 10.1177/1089253215570062] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Neurologic injury in the form of cognitive decline, delirium, and stroke are common phenomena in patients undergoing cardiac surgery and continues to be one of the most common complication after cardiac surgery, in spite of improvements in mortality and and improved surgical and anesthetic techniques. These complications lead to a significant increase in length of stay in the intensive care unit, increased length of hospital admission, and functional impairment, resulting in not only profound negative effects on patients who experience these complications, but also to increased costs of medical care and delivery. We discuss each of these complications in regard to their risks factors, incidence, potential therapeutic modalities, and relevant intraoperative and postoperative considerations.
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Affiliation(s)
| | | | - Jin Han
- Vanderbilt University, Nashville, TN, USA
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22
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Berger M, Nadler JW, Browndyke J, Terrando N, Ponnusamy V, Cohen HJ, Whitson HE, Mathew JP. Postoperative Cognitive Dysfunction: Minding the Gaps in Our Knowledge of a Common Postoperative Complication in the Elderly. Anesthesiol Clin 2015; 33:517-50. [PMID: 26315636 DOI: 10.1016/j.anclin.2015.05.008] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Postoperative cognitive dysfunction (POCD) is a common complication associated with significant morbidity and mortality in elderly patients. There is much interest in and controversy about POCD, reflected partly in the increasing number of articles published on POCD recently. Recent work suggests surgery may also be associated with cognitive improvement in some patients, termed postoperative cognitive improvement (POCI). As the number of surgeries performed worldwide approaches 250 million per year, optimizing postoperative cognitive function and preventing/treating POCD are major public health issues. In this article, we review the literature on POCD and POCI, and discuss current research challenges in this area.
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Affiliation(s)
- Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA.
| | - Jacob W Nadler
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Jeffrey Browndyke
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Niccolo Terrando
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Vikram Ponnusamy
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Harvey Jay Cohen
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Heather E Whitson
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University Medical Center, Duke South, Orange Zone, Room 4317, Durham, NC 27710, USA
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23
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Nadelson M, Sanders R, Avidan M. Neurotoxicity of general anaesthesia is hypothetical. Br J Anaesth 2015; 114:344-5. [DOI: 10.1093/bja/aeu476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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24
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Mashour GA, Woodrum DT, Avidan MS. Neurological complications of surgery and anaesthesia. Br J Anaesth 2014; 114:194-203. [PMID: 25204699 DOI: 10.1093/bja/aeu296] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Injury to the central and peripheral nervous systems is often permanent. As such, adverse neurological outcomes of surgery and anaesthesia can be devastating for patients and their families. In this article, we review the incidence, risk factors, outcomes, prevention, and treatment of a number of important neurological complications in the perioperative period.
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Affiliation(s)
- G A Mashour
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - D T Woodrum
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - M S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
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25
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26
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Reply: To PMID 23866798. Ann Thorac Surg 2014; 98:385-6. [PMID: 24996733 DOI: 10.1016/j.athoracsur.2014.04.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 03/28/2014] [Accepted: 04/22/2014] [Indexed: 11/20/2022]
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27
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Affiliation(s)
- Ola A Selnes
- Department of Neurology, The Johns Hopkins Hospital, Reed Hall West, 1620 McElderry St, Baltimore, MD21205-1911.
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