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Tarasova I, Trubnikova O, Kukhareva I, Syrova I, Sosnina A, Kupriyanova D, Barbarash O. A Comparison of Two Multi-Tasking Approaches to Cognitive Training in Cardiac Surgery Patients. Biomedicines 2023; 11:2823. [PMID: 37893196 PMCID: PMC10604887 DOI: 10.3390/biomedicines11102823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The multi-tasking approach may be promising for cognitive rehabilitation in cardiac surgery patients due to a significant effect on attentional and executive functions. This study aimed to compare the neuropsychological changes in patients who have undergone two variants of multi-tasking training and a control group in the early postoperative period of coronary artery bypass grafting (CABG). METHODS One hundred and ten CABG patients were divided into three groups: cognitive training (CT) I (a postural balance task with mental arithmetic, verbal fluency, and divergent tasks) (n = 30), CT II (a simple visual-motor reaction with mental arithmetic, verbal fluency, and divergent tasks) (n = 40), and control (n = 40). RESULTS Two or more cognitive indicators improved in 93.3% of CT I patients, in 72.5% of CT II patients, and in 62.5% of control patients; CT I patients differed from CT II and control (p = 0.04 and p = 0.008, respectively). The improving short-term memory and attention was found more frequently in the CT I group as compared to control (56.7% vs. 15%; p = 0.0005). The cognitive improvement of all domains (psychomotor and executive functions, attention, and short-term memory) was also revealed in CT I patients more frequently than CT II (46.7% vs. 20%; p = 0.02) and control (46.7% vs. 5%; p = 0.0005). CONCLUSIONS The CT I multi-tasking training was more effective at improving the cognitive performance in cardiac surgery patients as compared to CT II training and standard post-surgery management. The findings of this study will be helpful for future studies involving multi-tasking training.
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Affiliation(s)
- Irina Tarasova
- Department of Clinical Cardiology, Research Institute for Complex Issues of Cardiovascular Diseases, Sosnovy Blvd., 6, 650002 Kemerovo, Russia; (O.T.); (I.S.)
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Papatsimpas V, Vrouva S, Papathanasiou G, Papadopoulou M, Bouzineki C, Kanellopoulou S, Moutafi D, Bakalidou D. Does Therapeutic Exercise Support Improvement in Cognitive Function and Instrumental Activities of Daily Living in Patients with Mild Alzheimer's Disease? A Randomized Controlled Trial. Brain Sci 2023; 13:1112. [PMID: 37509042 PMCID: PMC10377697 DOI: 10.3390/brainsci13071112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
This randomized controlled trial aims to investigate the effect of 12 weeks of therapeutic exercise on cognitive function and daily activities in patients with mild Alzheimer's disease (AD). A total of 171 patients with mild AD from the Amarousion Day Care Center of the Alzheimer Society of Athens and the Athens General Hospital "G. Gennimatas" were randomly divided into three groups. Group A (aerobic and resistance exercise, n = 57), group B (resistance exercise, n = 57), and group C (control group, n = 57). Group A followed a weekly program consisting of 5 days with 30 min walking and 3 days with resistance exercises for about 45 min. Group B followed only a resistance exercise program, the same as group A. Group C did not participate in any exercise program. After the intervention, cognitive function was assessed with the Cognitive Examination-Revised (ACE-R), Trail Making Test A-B (TMT A-B), and Digit Span Test Forward and Backward (DST F-B) and daily activities with the instrumental activities of daily living scale (IADLs). A significant intervention effect was observed for all outcome measures (global cognitive function and instrumental activities of daily living). ANCOVA Bonferroni corrected post hoc tests revealed that the aerobic and resistance group improved compared to the control group on all measurement scales. The resistance group also showed an improvement compared to the control group. No significant effects were found between the aerobic and resistance group and the resistance group in any of the outcome measures.
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Affiliation(s)
- Vasileios Papatsimpas
- Physiotherapy Department, School of Health and Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), School of Health and Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
- Department of Physical Therapy, General Hospital of Athens G. GENNIMATAS, 11527 Athens, Greece
| | - Sotiria Vrouva
- Physiotherapy Department, School of Health and Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), School of Health and Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
- Department of Physical Therapy, 401 Army General Hospital of Athens, 11525 Athens, Greece
| | - George Papathanasiou
- Physiotherapy Department, School of Health and Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), School of Health and Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
| | - Marianna Papadopoulou
- Physiotherapy Department, School of Health and Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), School of Health and Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
| | | | | | - Dimitra Moutafi
- Pathological Department, General Hospital Konstantopouleio, 14233 Nea Ionia, Greece
| | - Daphne Bakalidou
- Physiotherapy Department, School of Health and Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), School of Health and Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
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Samiefard M, Fadardi JS, Kareshki H, Stacy AW. Validity and Reliability of a Revised S-UPPS-P Impulsive Behavior Scale: The Interplay between Impulsivity and Working Memory. J Pers Assess 2023; 105:174-186. [PMID: 35703735 DOI: 10.1080/00223891.2022.2081922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Impulsivity is a multidimensional construct. The UPPS-P model of impulsivity differentiates five distinct dimensions: negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking. The present study, reports the first translation and validation of the recently revised short form of the UPPS-P scale (S-UPPS-P) on a Persian-speaking sample, examining the relationship between impulsivity and working memory. who also completed the Positive and Negative Affect Scale (PANAS), the Buss and Perry Aggression Questionnaire, the Behavioral Inhibition and Activation Scales (BIS/BAS), and the Wechsler Digit Span Task (WDST). A series of confirmatory factor analyses, and Cronbach's alpha results supported the factor structure of the scale. The findings supported the S-UPPS-P model's hypothesized correlations with PANAS, aggressiveness, and the construct validity of the model. The results of hierarchical regression analysis showed that backward and forward digit span scores of the WDST predicted the S-UPPS-P impulsivity scores over the portion explained by BIS/BAS, PANAS, and aggression scores. To conclude, the revised S-UPPS-P Impulsive Behavior Scale was well supported even in a very different population than usually sampled, adding to growing evidence that it assesses distinct but interrelated aspects of the impulsivity construct. Our findings also suggest that attentional capacities and working memory play important roles in the prediction of impulsivity.
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Affiliation(s)
| | - Javad Salehi Fadardi
- Ferdowsi University of Mashhad, Mashhad, Iran.,Bangor University, Bangor, United Kingdom.,Claremont Graduate University, Claremont, USA
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4
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Eastus CC, Baez DE, Buckley ML, Lee J, Adami A. The role of structured exercise interventions on cognitive function in older individuals with stable Chronic Obstructive Pulmonary Disease: A scoping review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:987356. [PMID: 36386775 PMCID: PMC9659625 DOI: 10.3389/fresc.2022.987356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023]
Abstract
UNLABELLED A decline in cognitive performance has been associated with disease severity, exacerbations rate, presence of comorbidities, and low activity level in people with chronic obstructive pulmonary disease (COPD). Participation in exercise programs appears to have neuroprotective effects and to improve cognitive performance in older people. The present work undertook a scoping review of the effects of exercise-based interventions on cognitive function in older individuals with stable COPD. METHODS The methodological framework for scoping review was used and electronic searches of five databases performed. Original research and observational studies published between January 2010 and December 2021, administering exercise-based interventions and cognitive function evaluation, were included. RESULTS Of 13 full-text manuscripts assessed for eligibility, five were allocated to analysis. Three studies administered exercise training within pulmonary outpatient rehabilitation program (PR), and one inpatient PR. The fifth study conducted a structured training intervention in which either aerobic or a combination with resistance exercises were included. Twelve cognitive function screening tools were used in the five studies included in the analysis. Results extracted were based on 245 COPD (33% female) with moderate to very-severe airflow limitation. Interventions ranged from 12 to 36 sessions. Studies reported statistically significant improvements after intervention in different cognitive function domains, such as global cognition, immediate and delayed recall ability, cognitive flexibility, verbal fluency, attention, abstract reasoning, praxis ability. CONCLUSIONS Exercise-based interventions improve several areas of cognitive function in patients with stable COPD. However, the magnitude of gain varies among studies, and this is possibly due to the heterogeneity of tests used. Future research is needed to validate the optimal battery of screening tests, and to support the definition of guidelines for cognitive function evaluation in COPD.
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Affiliation(s)
- Caroline C. Eastus
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, United States
| | - Daniel E. Baez
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, United States
| | - Maria L. Buckley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Jungeun Lee
- College of Nursing, University of Rhode Island, Kingston, RI, United States
| | - Alessandra Adami
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, United States,Correspondence: Alessandra Adami
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Mutoh T, Kunitoki K, Tatewaki Y, Yamamoto S, Thyreau B, Matsudaira I, Kawashima R, Taki Y. Impact of medium-chain triglycerides on gait performance and brain metabolic network in healthy older adults: a double-blind, randomized controlled study. GeroScience 2022; 44:1325-1338. [PMID: 35380356 DOI: 10.1007/s11357-022-00553-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/21/2022] [Indexed: 12/22/2022] Open
Abstract
Nutritional supplementation with medium-chain triglycerides (MCTs) has the potential to increase memory function in elderly patients with frailty and dementia. Our aim was to investigate the effects of MCT on cognitive and gait functions and their relationships with focal brain metabolism and functional connectivity even in healthy older adults. Participants were blindly randomized and allocated to two groups: 18 g/day of MCT oil and matching placebo formula (control) administered as a jelly stick (6 g/pack, ingested three times a day). Gait analysis during the 6-m walk test, cognition, brain focal glucose metabolism quantified by 18F-fluorodeocyglucose positron emission tomography, and magnetic resonance imaging-based functional connectivity were assessed before and after a 3-month intervention. Sixty-three healthy, normal adults (females and males) were included. Compared with the control group, the MCT group showed better balance ability, as represented by the lower Lissajous index (23.1 ± 14.4 vs. 31.3 ± 18.9; P < 0.01), although no time × group interaction was observed in cognitive and other gait parameters. Moreover, MCT led to suppressed glucose metabolism in the right sensorimotor cortex compared with the control (P < 0.001), which was related to improved balance (r = 0.37; P = 0.04) along with increased functional connectivity from the ipsilateral cerebellar hemisphere. In conclusion, a 3-month MCT supplementation improves walking balance by suppressing glucose metabolism, which suggests the involvement of the cerebro-cerebellar network. This may reflect, at least in part, the inverse reaction of the ketogenic switch as a beneficial effect of long-term MCT dietary treatment.
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Affiliation(s)
- Tatsushi Mutoh
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan. .,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Aoba-ku, Sendai, 980-8575, Japan. .,Department of Neurosurgery, Research Institute for Brain and Blood Vessels-AKITA, Senshu-Kubota-machi, Akita, 010-0874, Japan.
| | - Keiko Kunitoki
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Yasuko Tatewaki
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Aoba-ku, Sendai, 980-8575, Japan
| | - Shuzo Yamamoto
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Aoba-ku, Sendai, 980-8575, Japan
| | - Benjamin Thyreau
- Smart-Aging Research Center, Tohoku University, Aoba-ku, Sendai, 980-8575, Japan
| | - Izumi Matsudaira
- Smart-Aging Research Center, Tohoku University, Aoba-ku, Sendai, 980-8575, Japan
| | - Ryuta Kawashima
- Department of Functional Brain Imaging, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, 980-8575, Japan
| | - Yasuyuki Taki
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan. .,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Aoba-ku, Sendai, 980-8575, Japan. .,Smart-Aging Research Center, Tohoku University, Aoba-ku, Sendai, 980-8575, Japan.
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Wang Y, Machizawa MG, Lisle T, Williams CL, Clarke R, Anzivino M, Kron I, Lee KS. Suppression of Neuroinflammation Attenuates Persistent Cognitive and Neurogenic Deficits in a Rat Model of Cardiopulmonary Bypass. Front Cell Neurosci 2022; 16:780880. [PMID: 35281295 PMCID: PMC8907423 DOI: 10.3389/fncel.2022.780880] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/25/2022] [Indexed: 01/24/2023] Open
Abstract
Post-operative cognitive dysfunction (POCD) can be a serious surgical complication, and patients undergoing cardiac procedures are at particular risk for POCD. This study examined the effect of blocking neuroinflammation on behavioral and neurogenic deficits produced in a rat model of cardiopulmonary bypass (CPB). Minocycline, a drug with established anti-inflammatory activity, or saline was administered daily for 30 days post-CPB. Treatment with minocycline reduced the number of activated microglia/macrophages observed in the dentate gyrus of the hippocampus at 6 months post-CPB, consistent with an anti-inflammatory action in this CPB model. Behavioral testing was conducted at 6 months post-CPB utilizing a win-shift task on an 8-arm radial maze. Minocycline-treated animals performed significantly better than saline-treated animals on this task after CPB. In addition, the CPB-induced reduction in adult neurogenesis was attenuated in the minocycline-treated animals. Together, these findings indicate that suppressing neuroinflammation during the early post-surgical phase can limit long-term deficits in both behavioral and neurogenic outcomes after CPB.
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Affiliation(s)
- Yi Wang
- Department of Neuroscience, University of Virginia, Charlottesville, VA, United States
- Department of Surgery, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA, United States
| | - Maro G. Machizawa
- Department of Neuroscience, University of Virginia, Charlottesville, VA, United States
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Turner Lisle
- Department of Surgery, Vail Health, Vail, CO, United States
| | - Cedric L. Williams
- Department of Psychology, University of Virginia, Charlottesville, VA, United States
| | - Ryon Clarke
- Department of Neuroscience, University of Virginia, Charlottesville, VA, United States
| | - Matthew Anzivino
- Department of Neuroscience, University of Virginia, Charlottesville, VA, United States
| | - Irving Kron
- Department of Health Sciences, University of Arizona, Tucson, AZ, United States
| | - Kevin S. Lee
- Department of Neuroscience, University of Virginia, Charlottesville, VA, United States
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
- Center for Brain Immunology and Glia (BIG), University of Virginia, Charlottesville, VA, United States
- *Correspondence: Kevin S. Lee,
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Syrova I, Kovalenko A, Trubnikova O, Maleva O, Chernobai A, Lozhkin I, Barbarash O. Cerebrovascular complications in patients with moderate and small stenosis of the carotid arteries in the hospital period of coronary artery bypass grafting using cardiopulmonary bypass. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:73-79. [DOI: 10.17116/jnevro202212208173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Amiel Castro R, Kunovac Kallak T, Sundström Poromaa I, Willebrand M, Lager S, Ehlert U, Skalkidou A. Pregnancy-related hormones and COMT genotype: Associations with maternal working memory. Psychoneuroendocrinology 2021; 132:105361. [PMID: 34333317 DOI: 10.1016/j.psyneuen.2021.105361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/29/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022]
Abstract
Women experience different degrees of subjective cognitive changes during pregnancy. The exact mechanism underlying these changes is unknown, although endocrine alterations and genetics may be contributing factors. We investigated whether multiple pregnancy-related hormones were associated with working memory function assessed with the Digit Span Test (DST) in late pregnancy. Moreover, we examined whether the catechol-O-methyltransferase (COMT) genotype, previously related to working memory, was an effect modifier in this association. In this population-based panel study, we recorded psychiatric history, medication use, socio-demographic characteristics, and psychological well-being, gathered blood and saliva samples, and administered the DST at gestational weeks 35-39 (N = 216). We conducted multivariate linear regressions with DST as outcome, with different hormones and COMT genotype, adjusting for covariates including maternal age, BMI, education, depressive symptoms, and parity. We repeated these analyses excluding women with elevated depressive symptoms. Higher DST total scores were associated with increased free estradiol concentrations (B = 0.01, p = 0.03; B = 0.01, p = 0.02) in all participants and in participants without depressive symptoms, respectively, whereas DST forward was positively associated with free estradiol only in women without depressive symptoms (B = 0.01, p = 0.04). Lower total testosterone concentrations (B = -0.03, p = 0.01) enhanced DST backward performance in non-depressed women. Maternal higher education was significantly associated with the DST subscales in all participants. No significant differences emerged when considering the COMT genotype. Our results suggest differential associations of free estradiol and total testosterone levels with working memory function in late pregnancy.
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Affiliation(s)
- Rita Amiel Castro
- University of Zurich, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Binzmühlestrasse 14/26, 8050 Zurich, Switzerland.
| | - Theodora Kunovac Kallak
- Uppsala University, Department of Women's and Children's Health, Dag Hammarskjölds väg 14B, 1 tr, 75237 Uppsala, Sweden
| | - Inger Sundström Poromaa
- Uppsala University, Department of Women's and Children's Health, Dag Hammarskjölds väg 14B, 1 tr, 75237 Uppsala, Sweden
| | - Mimmie Willebrand
- Uppsala University, Department of Neuroscience, Akademiska sjukhuset 75185 Uppsala, Sweden
| | - Susanne Lager
- Uppsala University, Department of Women's and Children's Health, Dag Hammarskjölds väg 14B, 1 tr, 75237 Uppsala, Sweden
| | - Ulrike Ehlert
- University of Zurich, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Binzmühlestrasse 14/26, 8050 Zurich, Switzerland
| | - Alkistis Skalkidou
- Uppsala University, Department of Women's and Children's Health, Dag Hammarskjölds väg 14B, 1 tr, 75237 Uppsala, Sweden
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Snyder B, Simone SM, Giovannetti T, Floyd TF. Cerebral Hypoxia: Its Role in Age-Related Chronic and Acute Cognitive Dysfunction. Anesth Analg 2021; 132:1502-1513. [PMID: 33780389 DOI: 10.1213/ane.0000000000005525] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Postoperative cognitive dysfunction (POCD) has been reported with widely varying frequency but appears to be strongly associated with aging. Outside of the surgical arena, chronic and acute cerebral hypoxia may exist as a result of respiratory, cardiovascular, or anemic conditions. Hypoxia has been extensively implicated in cognitive impairment. Furthermore, disease states associated with hypoxia both accompany and progress with aging. Perioperative cerebral hypoxia is likely underdiagnosed, and its contribution to POCD is underappreciated. Herein, we discuss the various disease processes and forms in which hypoxia may contribute to POCD. Furthermore, we outline hypoxia-related mechanisms, such as hypoxia-inducible factor activation, cerebral ischemia, cerebrovascular reserve, excitotoxicity, and neuroinflammation, which may contribute to cognitive impairment and how these mechanisms interact with aging. Finally, we discuss opportunities to prevent and manage POCD related to hypoxia.
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Affiliation(s)
- Brina Snyder
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Tania Giovannetti
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Thomas F Floyd
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Risk factors and predictive value of perioperative neurocognitive disorders in elderly patients with gastrointestinal tumors. BMC Anesthesiol 2021; 21:193. [PMID: 34281529 PMCID: PMC8287702 DOI: 10.1186/s12871-021-01405-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study aims to investigate the risk factors of perioperative neurocognitive disorders (PNDs) mainly including postoperative cognitive dysfunction (POCD) in elderly patients with gastrointestinal tumors, and evaluate its predictive value. METHODS A total of 222 eligible elderly patients (≥65 years) scheduled for elective gastroenterectomy under general anesthesia were enrolled. The cognitive function assessment was carried out 1 day before surgery and 7 days after surgery. Receiver operating characteristic curve analysis was performed to evaluate the predictive value of risk factors for early POCD. The risk factors for POCD were analyzed using univariate and multivariate logistic regression model. RESULTS Of all the 222 enrolled patients, 91 (41.0%) developed early POCD and 40 (18.0%) were identified as major POCD within 7 days after the surgery. Visual analogue score (VAS, 1st day, resting) ≥4 (OR = 7.618[3.231-17.962], P < 0.001) and alcohol exposure (OR = 2.398[1.174-4.900], P = 0.016) were independent risk factors for early POCD. VAS score (1st, resting) ≥4 (OR = 13.823[4.779-39.981], P < 0.001), preoperative white blood cell (WBC) levels ≥10 × 10*9/L (OR = 5.548[1.128-26.221], P = 0.035), blood loss ≥500 ml (OR = 3.317[1.094-10.059], P = 0.034), history of hypertension (OR = 3.046[1.267-7.322], P = 0.013), and neutrophil-lymphocyte ratio (NLR) ≥2 (OR = 3.261[1.020-10.419], P = 0.046) were independent risk factors for major POCD. Receiver operating characteristic curve analysis indicated that VAS score (1st day, resting) was a significant predictor for major POCD with a cut-off value of 2.68 and an area under the curve of 0.860 (95% confidence interval: 0.801-0.920, P < 0.001). CONCLUSIONS The risk factors for early POCD after gastroenterectomy included high VAS score (1st day, resting) and alcohol exposure. High VAS score, preoperative WBC levels ≥10 × 10*9/L, blood loss ≥500 ml, NLR ≥2, and history of hypertension were independent risk factors for major POCD. Among them, VAS score was one of the important predictors.
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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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Riordan P, Davis M. Anxiety and psychological management of heart disease and heart surgery. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:393-408. [PMID: 33632455 DOI: 10.1016/b978-0-12-819814-8.00026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Anxiety is associated with many forms and facets of heart disease, and, by extension, neurologic manifestations of heart disease. Despite its seeming self-evidence, anxiety is challenging to consistently define, measure, and operationalize in the context of medical research. Various diagnostic nosologies have been defined and refined over time, but anxiety is also a universal human experience that may be "normal" in many circumstances, particularly in the face of major medical issues. For these and other reasons, the research on anxiety and heart disease is mixed, incomplete, and often characterized by challenging questions of causality. Nonetheless, a broad body of literature has established clear connections between anxiety and vascular risk factors, cardiac disease, and cardiac surgery. These relationships are often intuitive, with research suggesting, for example, that chronic activation of the sympathetic nervous system is associated with increased risk of heart disease. However, they are sometimes complexly reciprocal or even surprising (e.g., with high-anxiety individuals found to have better outcomes in some cardiac conditions by virtue of seeking evaluation and treatment earlier). This chapter reviews the construct of anxiety and its complexities, its associations with heart disease, and the established treatments for anxiety, concluding with questions about anxiety, heart disease, and their optimal management that still need to be answered.
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Affiliation(s)
- Patrick Riordan
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, United States.
| | - Matthew Davis
- Mental Health Service Line, Edward Hines Jr. VA Hospital, Hines, IL, United States
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Wang Y, Tache-Leon C, Machizawa MG, Lisle T, Williams C, Clarke RH, Anzivino MJ, Kron I, Lee KS. Persistent cognitive deficits and neuroinflammation in a rat model of cardiopulmonary bypass. J Thorac Cardiovasc Surg 2020; 160:e185-e188. [PMID: 32037237 PMCID: PMC8754258 DOI: 10.1016/j.jtcvs.2019.12.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Yi Wang
- Department of Neuroscience, University of Virginia, Charlottesville, Va
| | | | - Maro G Machizawa
- Department of Neuroscience, University of Virginia, Charlottesville, Va
| | - Turner Lisle
- Department of Surgery, University of Virginia, Charlottesville, Va
| | - Cedric Williams
- Department of Psychology, University of Virginia, Charlottesville, Va
| | - Ryon H Clarke
- Department of Neuroscience, University of Virginia, Charlottesville, Va
| | | | - Irving Kron
- Department of Surgery, University of Virginia, Charlottesville, Va
| | - Kevin S Lee
- Department of Neuroscience, University of Virginia, Charlottesville, Va; Department of Neurosurgery, University of Virginia, Charlottesville, Va; Center for Brain, Immunology, and Glia, University of Virginia, Charlottesville, Va.
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Li Y, Zhang B. Effects of anesthesia depth on postoperative cognitive function and inflammation: a systematic review and meta-analysis. Minerva Anestesiol 2020; 86:965-973. [DOI: 10.23736/s0375-9393.20.14251-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Xia C, Vonder M, Sidorenkov G, Oudkerk M, de Groot JC, van der Harst P, de Bock GH, De Deyn PP, Vliegenthart R. The Relationship of Coronary Artery Calcium and Clinical Coronary Artery Disease with Cognitive Function: A Systematic Review and Meta-Analysis. J Atheroscler Thromb 2020; 27:934-958. [PMID: 32062643 PMCID: PMC7508729 DOI: 10.5551/jat.52928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
AIM Coronary artery disease (CAD) and cognitive impairment are common in the elderly, with evidence for shared risk factors and pathophysiological processes. The coronary artery calcium (CAC) score is a marker of subclinical CAD, which may allow early detection of individuals prone to cognitive decline. Prior studies on associations of CAC and clinical CAD with cognitive impairment had discrepant results. This systematic review aims to evaluate the association of (sub)clinical CAD with cognitive function, cognitive decline, and diagnosis of mild cognitive impairment (MCI) or dementia. METHODS A systematic search was conducted in MEDLINE, Embase, and Web of Science until February 2019, supplemented with citations tracking. Two reviewers independently screened studies and extracted information including odds ratios (ORs) and hazard ratios (HRs). RESULTS Forty-six studies, 10 on CAC and 36 on clinical CAD, comprising 1,248,908 participants were included in the systematic review. Studies about associations of (sub)clinical CAD with cognitive function and cognitive decline had heterogeneous methodology and inconsistent findings. Two population-based studies investigated the association between CAC and risk of dementia over 6-12.2 years using different CAC scoring methods. Both found a tendency toward higher risk of dementia as CAC severity increased. Meta-analysis in 15 studies (663,250 individuals) showed an association between CAD and MCI/dementia (pooled OR 1.32, 95%CI 1.17-1.48) with substantial heterogeneity (I2=87.0%, p<0.001). Pooled HR of CAD for incident MCI/dementia over 3.2-25.5 years in six longitudinal studies (70,060 individuals) was 1.51 (95%CI 1.24-1.85), with low heterogeneity (I2=14.1%, p=0.32). Sensitivity analysis did not detect any study that was of particular influence on the pooled OR or HR. CONCLUSIONS Limited evidence suggests the CAC score is associated with risk of dementia. In clinical CAD, risk of MCI and dementia is increased by 50%, as supported by stronger evidence.
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Affiliation(s)
- Congying Xia
- University of Groningen, University Medical Center Groningen, Department of Radiology
| | - Marleen Vonder
- University of Groningen, University Medical Center Groningen, Department of Epidemiology
| | - Grigory Sidorenkov
- University of Groningen, University Medical Center Groningen, Department of Epidemiology
| | | | - Jan Cees de Groot
- University of Groningen, University Medical Center Groningen, Department of Radiology
| | - Pim van der Harst
- University of Groningen, University Medical Center Groningen, Department of Cardiology
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology
| | - Peter Paul De Deyn
- University of Groningen, University Medical Center Groningen, Department of Neurology, Alzheimer Center Groningen
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State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018. Br J Anaesth 2019; 123:464-478. [PMID: 31439308 DOI: 10.1016/j.bja.2019.07.004] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 12/20/2022] Open
Abstract
Cognitive recovery after anaesthesia and surgery is a concern for older adults, their families, and caregivers. Reports of patients who were 'never the same' prompted a scientific inquiry into the nature of what patients have experienced. In June 2018, the ASA Brain Health Initiative held a summit to discuss the state of the science on perioperative cognition, and to create an implementation plan for patients and providers leveraging the current evidence. This group included representatives from the AARP (formerly the American Association of Retired Persons), American College of Surgeons, American Heart Association, and Alzheimer's Association Perioperative Cognition and Delirium Professional Interest Area. This paper summarises the state of the relevant clinical science, including risk factors, identification and diagnosis, prognosis, disparities, outcomes, and treatment of perioperative neurocognitive disorders. Finally, we discuss gaps in current knowledge with suggestions for future directions and opportunities for clinical and translational projects.
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Oldham MA, Vachon J, Yuh D, Lee HB. Cognitive Outcomes After Heart Valve Surgery: A Systematic Review and Meta-Analysis. J Am Geriatr Soc 2018; 66:2327-2334. [PMID: 30307031 DOI: 10.1111/jgs.15601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To summarize evidence on cognitive outcomes after heart valve surgery; secondary aim, to examine whether aortic and mitral valve surgery are associated with different cognitive outcomes. DESIGN Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review and meta-analysis. SETTING Cardiac surgery. PARTICIPANTS Individuals undergoing heart valve surgery. MEASUREMENTS We searched MEDLINE, EMBASE, and PsycINFO for peer-reviewed reports of individuals undergoing heart valve surgery who underwent pre- and postoperative cognitive assessment. Our initial search returned 1,475 articles, of which 12 were included. Postoperative cognitive results were divided into those from 1 week to 1 month (early outcomes, npooled = 450) and from 2 to 6 months (intermediate outcomes; npooled = 722). No studies with longer-term outcomes were identified. RESULTS Subjects had moderate early cognitive decline from baseline (Becker mean gain effect size (ES)=-0.39 ± 0.27) that improved slightly by 2 to 6 months (ES=-0.25 ± 0.38). Individuals undergoing aortic valve surgery-who were older on average than those undergoing mitral valve surgery (68 vs 57)-had greater early cognitive decline than those undergoing mitral valve surgery (ES=-0.68 vs -0.12), but both cohorts had similar decline 2 to 6 months postoperatively (ES=-0.27 vs -0.20). CONCLUSIONS Heart valve surgery is associated with cognitive decline over the 6 months after surgery, but outcomes beyond 6 months are unclear. These findings highlight the cognitive vulnerability of this population, especially older adults with aortic stenosis. © 2018 American Geriatrics Society and Wiley Periodicals, Inc. J Am Geriatr Soc 66:2327-2334, 2018.
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Affiliation(s)
- Mark A Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Jacqueline Vachon
- Oncology Department, Ingram School of Nursing, McGill University, Montréal, Quebec, Canada
| | - David Yuh
- Department of Surgery, Stamford Hospital, Stamford, Connecticut
| | - Hochang B Lee
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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Rosen AC, Soman S, Bhat J, Laird AR, Stephens J, Eickhoff SB, Fox PM, Long B, Dinishak D, Ortega M, Lane B, Wintermark M, Hitchner E, Zhou W. Convergence Analysis of Micro-Lesions (CAML): An approach to mapping of diffuse lesions from carotid revascularization. NEUROIMAGE-CLINICAL 2018; 18:553-559. [PMID: 29868451 PMCID: PMC5984594 DOI: 10.1016/j.nicl.2018.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/19/2017] [Accepted: 01/18/2018] [Indexed: 11/25/2022]
Abstract
Carotid revascularization (endarterectomy, stenting) prevents stroke; however, procedure-related embolization is common and results in small brain lesions easily identified by diffusion weighted magnetic resonance imaging (DWI). A crucial barrier to understanding the clinical significance of these lesions has been the lack of a statistical approach to identify vulnerable brain areas. The problem is that the lesions are small, numerous, and non-overlapping. Here we address this problem with a new method, the Convergence Analysis of Micro-Lesions (CAML) technique, an extension of the Anatomic Likelihood Analysis (ALE). The method combines manual lesion tracing, constraints based on known lesion patterns, and convergence analysis to represent regions vulnerable to lesions as probabilistic brain atlases. Two studies were conducted over the course of 12 years in an active, vascular surgery clinic. An analysis in an initial group of 126 patients at 1.5 T MRI was cross-validated in a second group of 80 patients at 3T MRI. In CAML, lesions were manually defined and center points identified. Brains were aligned according to side of surgery since this factor powerfully determines lesion distribution. A convergence based analysis, was performed on each of these groups. Results indicated the most consistent region of vulnerability was in motor and premotor cortex regions. Smaller regions common to both groups included the dorsolateral prefrontal cortex and medial parietal regions. Vulnerability of motor cortex is consistent with previous work showing changes in hand dexterity associated with these procedures. The consistency of CAML also demonstrates the feasibility of this new approach to characterize small, diffuse, non-overlapping lesions in patients with multifocal pathologies. Convergence Analysis of Micro-Lesions technique finds patterns in diffuse lesions. Lesions from carotid revascularization affect consistent brain targets. Motor cortex is the most vulnerable brain region to these lesions.
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Affiliation(s)
- Allyson C Rosen
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Department of Psychiatry, Stanford University, Stanford, CA 94305, United States.
| | - Salil Soman
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA 00215, United States
| | - Jyoti Bhat
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Palo Alto Veterans Institute for Research, Palo Alto, CA 94304, United States
| | - Angela R Laird
- Department of Physics, School of Integrated Science and Humanity, Florida International University, Miami, FL 33199, United States
| | - Jeffrey Stephens
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States
| | - Simon B Eickhoff
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - P Mickle Fox
- Research Imaging Institute, The University of Texas Health Science Center at San Antonio, TX 78229, United States
| | - Becky Long
- Department of Surgery, Stanford University, Stanford, CA 94305, United States; Department of Surgery, Texas Tech University Health Science Center El Paso, TX 79905, United States
| | - David Dinishak
- Palo Alto University, Redwood City, CA 94063, United States
| | - Mario Ortega
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Barton Lane
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Department of Radiology, Stanford University, Stanford, CA 94305, United States
| | - Max Wintermark
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Department of Radiology, Stanford University, Stanford, CA 94305, United States
| | - Elizabeth Hitchner
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Department of Vascular Surgery, Stanford University, Stanford, CA 94305, United States
| | - Wei Zhou
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA 94304, United States; Department of Vascular Surgery, Stanford University, Stanford, CA 94305, United States; Department of Surgery, Tucson, AZ 85724-5066, United States
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Anoxia-Hypoxia in Forensic Neuropsychological Assessment: Cognitive Impact of Pulmonary Injuries, Respiratory Distress, Cerebral Blood Hypoperfusion, and Major Surgeries. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9319-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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20
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Molardi A, Di Chicco MV, Carino D, Goldoni M, Ricci M, Borrello B, Gripshi F, Gherli T, Nicolini F. The use of RemoweLL oxygenator-integrated device in the prevention of the complications related to aortic valve surgery in the elderly patient: Preliminary results. Eur J Prev Cardiol 2018; 25:59-65. [PMID: 29708031 DOI: 10.1177/2047487318756432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The effects of fat microembolization due to cardiopulmonary bypass are well known in cardiac surgery. Our aim is to evaluate the use of the RemoweLL device (Eurosets, Medolla, Italy) during elective aortic valve replacement in elderly patients (>70 years old) to rate its biochemical and clinical effects. The RemoweLL device is an oxygenator-integrated reservoir which combines two strategies for fat emboli and leucocytes removal: filtration and supernatant elimination. Methods Forty-four elderly patients were enrolled and assigned randomly to a Group A (standard device) and a Group B (RemoweLL). Biochemical effects were evaluated by blood samples, which were tested for white blood cells, neutrophils, protein SP-100 and interleukin 6 besides standard lab tests. Our clinical endpoints were any type of neurological, cardiac, respiratory, gastrointestinal or renal complications, and length of stay in the intensive care unit. Statistical analysis was carried out with chi square test for non-parametric data; t test and analysis of variance for repeated measures were used for parametric data. Results Group B showed lower levels of white blood cells, neutrophils, interleukin 6 and protein SP-100 immediately and 24 hours after the operation. Group B also showed a lower amount of neurocognitive type II dysfunction even if the length of stay in the ICU did not change. Conclusions The RemoweLL system is safe and effective in reducing inflammatory response to cardiopulmonary bypass and it could be a useful tool in minimizing negative effects of cardiopulmonary bypass; however, it does not seem to have any effect on elderly patients' hospital stay.
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Affiliation(s)
- Alberto Molardi
- 1 Department of General and Specialized Surgery, Cardiac Surgery Unit, University Hospital of Parma, Italy
| | - Maria V Di Chicco
- 2 Department of Medicine and Surgery, University Medical School, University of Parma, Italy
| | - Davide Carino
- 2 Department of Medicine and Surgery, University Medical School, University of Parma, Italy
| | - Matteo Goldoni
- 2 Department of Medicine and Surgery, University Medical School, University of Parma, Italy
| | - Matteo Ricci
- 2 Department of Medicine and Surgery, University Medical School, University of Parma, Italy
| | - Bruno Borrello
- 1 Department of General and Specialized Surgery, Cardiac Surgery Unit, University Hospital of Parma, Italy
| | - Florida Gripshi
- 2 Department of Medicine and Surgery, University Medical School, University of Parma, Italy
| | - Tiziano Gherli
- 2 Department of Medicine and Surgery, University Medical School, University of Parma, Italy
| | - Francesco Nicolini
- 2 Department of Medicine and Surgery, University Medical School, University of Parma, Italy
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Dokkedal U, Wod M, Thinggaard M, Hansen TG, Rasmussen LS, Mengel-From J, Christensen K. No impact of surgery on cognitive function: a longitudinal study of middle-aged Danish twins. Ann Epidemiol 2018; 28:95-101.e1. [DOI: 10.1016/j.annepidem.2017.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/29/2017] [Accepted: 12/06/2017] [Indexed: 12/13/2022]
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Khan MM, Herrmann N, Gallagher D, Gandell D, Fremes SE, Wijeysundera HC, Radhakrishnan S, Sun YR, Lanctôt KL. Cognitive Outcomes After Transcatheter Aortic Valve Implantation: A Metaanalysis. J Am Geriatr Soc 2017; 66:254-262. [PMID: 29159840 DOI: 10.1111/jgs.15123] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To quantitatively summarize changes in cognitive performance in individuals with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). DESIGN Metaanalysis. PARTICIPANTS Individuals undergoing TAVI (N = 1,065 (48.5% male) from 18 studies, average age ≥80). MEASUREMENTS The MEDLINE, EMBASE, and Cochrane Central databases were searched for original peer-reviewed reports assessing cognitive performance using standardized cognitive tests before and after TAVI. Data were extracted for cognitive scores before TAVI; perioperatively (within 7 days after TAVI); 1, 3, and 6 months after TAVI, and 12 to 34 months after TAVI (over the long term). Standardized mean differences (SMDs) were generated using random-effects models for changes in cognition at each time point. Metaregression analyses were conducted to assess the association between population and procedural characteristics and cognitive outcomes. Risk of bias was assessed. RESULTS There were no significant changes from baseline in perioperative cognitive performance (SMD = 0.05, 95% confidence interval (CI) = -0.08-0.18; z = 0.75, P = .46), although overall cognitive performance had improved significantly 1 month after TAVI (SMD = -0.33, 95% CI = -0.50 to -0.16; z = 3.83, P < .001). There were no differences in cognitive performance 3 and 6 months after TAVI or over the long term. Cognitive outcomes were not associated with any covariates in regression analyses. CONCLUSION Cognitive performance is preserved after TAVI, suggesting TAVI is not detrimental to cognition.
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Affiliation(s)
- Maisha M Khan
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada
| | - Damien Gallagher
- Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada
| | - Dov Gandell
- Department of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Sam Radhakrishnan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yue Ran Sun
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Krista L Lanctôt
- Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada
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Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass. Can J Anaesth 2017; 64:1129-1137. [PMID: 28718100 DOI: 10.1007/s12630-017-0938-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/17/2017] [Accepted: 07/06/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Cardiopulmonary bypass (CPB) induces a significant inflammatory response that may increase the risk for delirium. We hypothesized that exposure to CPB during coronary artery bypass grafting (CABG) surgery would correlate with an increased risk of delirium. METHODS We reviewed clinical data from two databases at our medical centre - the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Patients undergoing elective CABG surgery (on-pump and off-pump) from November 1, 2009 to September 30, 2015 were included in the study. Delirium was defined as any postoperative positive Confusion Assessment Method for the Intensive Care Unit exam during the intensive care unit stay. We performed logistic regression to isolate the association between CPB exposure and delirium adjusted for predetermined risk factors and potential confounders. RESULTS During the study period, 2,280 patients underwent elective CABG surgery, with 384 patients (16.9%) exposed to CPB. Delirium was diagnosed in 451 patients (19.8%). Exposure to CPB showed a significant independent association with delirium. Patients exposed to CPB for 142 min (90th percentile of CPB duration) vs those exposed for 54 min (10th percentile) had an adjusted relative risk (RR) of delirium of 2.18 (95% confidence interval [CI], 1.39 to 3.07; P = 0.002) vs a RR of 1.51 (95% CI, 0.92 to 2.29; P = 0.10), respectively. CONCLUSIONS The use and duration of cardiopulmonary bypass were associated with an increased risk of delirium in patients undergoing CABG surgery. TRIAL REGISTRATION www.clinicaltrials.gov , NCT02548975. Registered 4 September 2015.
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Abstract
PURPOSE OF REVIEW This article discusses neurologic complications that can arise from cardiac and aortic disease and dysfunction. RECENT FINDINGS Advances in the care of patients with cardiac or aortic disease include the use of prolonged cardiac monitoring in cryptogenic stroke and the approval of the use of left atrial appendage closure devices for stroke prevention in patients with atrial fibrillation who are not candidates for anticoagulation. Continuing controversy surrounds patent foramen ovale closure, and new evidence indicates that cognitive impairment following coronary artery bypass grafting surgery may be less common than previously thought. SUMMARY Dysfunction of the cardiovascular system can cause serious neurologic injury. In some cases, both the initial presenting symptom and the most serious damage done by cardiac or aortic dysfunction may be neurologic. Prompt recognition of the symptoms, combined with recent advances in both cardiology and neurology, may permit more accurate diagnoses, more effective treatment, and less injury to patients.
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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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Peterss S, Mansour AM, Zafar MA, Thombre K, Rizzo JA, Ziganshin BA, Darr UM, Elefteriades JA. Elective surgery for ascending aortic aneurysm in the elderly: should there be an age cut-off?†. Eur J Cardiothorac Surg 2017; 51:965-970. [DOI: 10.1093/ejcts/ezw437] [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: 08/24/2016] [Accepted: 12/20/2016] [Indexed: 11/14/2022] Open
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Ghanem A, Dörner J, Schulze-Hagen L, Müller A, Wilsing M, Sinning JM, Lütkens J, Frerker C, Kuck KH, Gräff I, Schild H, Werner N, Grube E, Nickenig G. Subacute Subclinical Brain Infarctions after Transcatheter Aortic Valve Implantation Negatively Impact Cognitive Function in Long-Term Follow-Up. PLoS One 2017; 12:e0168852. [PMID: 28056466 PMCID: PMC5215955 DOI: 10.1371/journal.pone.0168852] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 10/19/2016] [Indexed: 11/19/2022] Open
Abstract
Aims To date every post-procedural cerebrovascular embolic event (CVE) is dreaded for its potential to accelerate cognitive decline after transcatheter aortic valve implantation (TAVI). This study differentiates the impact of acute (procedural) and post-acute cerebrovascular embolic events (CVEs) on cognitive performance. Methods Magnetic resonance imaging (MRI) before, early and late after TAVI was performed to quantify embolic burden. Quantification of diffusion- and T1-weighted lesions, as well as white-matter and total brain volumes, as well as cognitive function testing (MMSE) were assessed in 28 patients with a medium follow-up period of 34 months. Results Procedural diffusion-weighted lesions were observed in 17 patients (61%), but demonstrated locoregional remnants only in a minority of patients in long-term follow-up (6.5%). Acute CVEs did not impact the trajectory of late silent brain infarctions (SBI), white-matter hyperintensities, and cerebral atrophy. Functionally, early CVEs did not affect cognitive function. In contrast, patients with “new” SBIs after TAVI had a trend to cognitive deterioration in long-term follow-up (“new”SBI: MMSE -1.4 / no “new”SBI: MMSE +1.5, p = 0.067). Interestingly, only a fraction of these “new” SBIs evolved from procedural CVEs (22.2%). Conclusions Aquired SBIs after TAVI, but not DW-CVE per se are associated with functional impairment long-term after TAVI. In the context of subacute thrombosis seen in TAVI prostheses, these findings set the stage for tailored stroke prevention and comprehensive surrogate endpoint definitions in neuroprotective trials.
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Affiliation(s)
- Alexander Ghanem
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Cardiology, University Hospital Bonn, Germany
- * E-mail: (AG); (GN)
| | - Jonas Dörner
- Department of Radiology, University Hospital Cologne, Germany
- Department of Radiology, University Hospital Bonn, Germany
| | | | - Andreas Müller
- Department of Radiology, University Hospital Bonn, Germany
| | - Marius Wilsing
- Department of Cardiology, University Hospital Bonn, Germany
| | | | - Julian Lütkens
- Department of Radiology, University Hospital Bonn, Germany
| | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Ingo Gräff
- Emergency Department, University Hospital Bonn, Bonn, Germany
| | - Hans Schild
- Department of Radiology, University Hospital Bonn, Germany
| | - Nikos Werner
- Department of Cardiology, University Hospital Bonn, Germany
| | - Eberhard Grube
- Department of Cardiology, University Hospital Bonn, Germany
| | - Georg Nickenig
- Department of Cardiology, University Hospital Bonn, Germany
- * E-mail: (AG); (GN)
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Cardiovascular disease biomarkers on cognitive function in older adults: Joint effects of cardiovascular disease biomarkers and cognitive function on mortality risk. Prev Med 2017; 94:27-30. [PMID: 27863954 DOI: 10.1016/j.ypmed.2016.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 10/15/2016] [Accepted: 11/12/2016] [Indexed: 11/20/2022]
Abstract
Previous research demonstrates an inverse association between age and cardiovascular disease (CVD) biomarkers with cognitive function; however, little is known about the combined associations of CVD risk factors and cognitive function with all-cause mortality in an older adult population, which was the purpose of this study. Data from the 1999-2002 NHANES were used (N=2,097; 60+yrs), with mortality follow-up through 2011. Evaluated individual biomarkers included mean arterial pressure (MAP), high-sensitivity C-reactive protein (CRP), HDL-C, total cholesterol (TC), A1C, and measured body mass index (BMI). Cognitive function was assessed using the Digit Symbol Substitution Test (DSST). Further, 4 groups were created based on CVD risk and cognitive function. Group 1: high cognitive function and low CVD risk; Group 2: high cognitive function and high CVD risk; Group 3: low cognitive function and low CVD risk; Group 4: low cognitive function and high CVD risk. An inverse relationship was observed where those with more CVD risk factors had a lower (worse) cognitive function score. Compared to those in Group 1, only those in Group 3 and 4 had an increase mortality risk.
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29
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Gholipour Baradari A, Habibi MR, Habibi V, Nouraei SM. Administration of lidocaine to prevent cognitive deficit in patients undergoing coronary artery bypass grafting and valve plasty: a systematic review and meta-analysis. Expert Rev Clin Pharmacol 2016; 10:179-185. [PMID: 27892772 DOI: 10.1080/17512433.2017.1266252] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The administration of lidocaine to maintain cognitive function following coronary artery bypass grafting (CABG) and valve plasty is a controversial concept in terms of its effectiveness. We performed a systematic review to determine the effectiveness of treatment with lidocaine in preventing the occurrence of cognitive deficit after cardiac surgery. Area covered: To review the current literature on the subject, we searched the PubMed database and the Cochrane Library database (up to May 2015) and compiled a list of retrieved articles. Our final review includes only randomized controlled trials (RCTs) that compared lidocaine to a control (placebo) following CABG and valve plasty. Statistical analysis of the odds ratio (OR) and corresponding 95% confidence interval (CI) were used to determine the overall effectiveness of lidocaine for the prevention of cognitive deficit with both procedures. The Mantel-Haenszel method was used to pool data of the outcomes of cognitive deficit occurrence into fixed-effect model meta-analyses. Five RCTs were included in this study, with a total of 688 patients. Perioperative administration of lidocaine in patients undergoing cardiac surgery reduced occurrence of cognitive deficit (OR 0.583 [95% CI 0.438-0.777]; Z = -3.680; P = 0.00; I2 = 52%). No significant difference in the early occurrence of cognitive deficit was revealed in patients after cardiac surgery (OR 0.909 [95% CI 0.600-1.376]; Z = -0.451; P = 0.652; I2 = 11%). Expert commentary: Cognitive deficit associated with cardiac surgery is a common postoperative event. Lidocaine is contributed to a significantly reduced occurrence of cognitive deficit. Cognitive deficit management is recommended.
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Affiliation(s)
- Afshin Gholipour Baradari
- a Department of Anesthesiology, Faculty of Medicine , Mazandaran University of Medical Sciences , Sari , Iran
| | - Mohammad Reza Habibi
- a Department of Anesthesiology, Faculty of Medicine , Mazandaran University of Medical Sciences , Sari , Iran
| | - Valiollah Habibi
- b Department of Cardiac Surgery, Faculty of Medicine , Mazandaran University of Medical Sciences , Sari , Iran
| | - Seyed Mahmood Nouraei
- b Department of Cardiac Surgery, Faculty of Medicine , Mazandaran University of Medical Sciences , Sari , Iran
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30
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Auffret V, Campelo-Parada F, Regueiro A, Del Trigo M, Chiche O, Chamandi C, Allende R, Cordoba-Soriano JG, Paradis JM, De Larochellière R, Doyle D, Dumont E, Mohammadi S, Côté M, Marrero A, Puri R, Rodés-Cabau J. Serial Changes in Cognitive Function Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2016; 68:2129-2141. [PMID: 27692728 DOI: 10.1016/j.jacc.2016.08.046] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/18/2016] [Accepted: 08/09/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Data regarding the mid- to long-term cognitive trajectory of transcatheter aortic valve (TAVR) recipients are scarce. OBJECTIVES Changes in global cognition and specific cognitive domains up to 1 year post-TAVR were evaluated. METHODS Fifty-one patients (median age 80.0 [interquartile range: 72.0 to 85.0] years; 37% women) underwent TAVR and prospective assessment of cognitive function using the Montreal Cognitive Assessment (MoCA) at baseline, short-term (30 days), and 1 year post-TAVR. Processing speed and executive cognitive functions were further evaluated with the digit-symbol substitution test (DSST), Trail Making Tests (TMT), and verbal fluency tests at the same time points. Cognitive decline (CD) was determined by changes in mean scores and as a rate using practice-corrected reliable change index (RCI). RESULTS The baseline mean total MoCA score was 22.71 ± 3.84. Twenty patients (39.2%) were considered cognitively impaired using a cutoff of <23 of 30 points. Mean total MoCA score improved at short-term post-TAVR and remained stable at 1 year (p = 0.022). On the basis of the RCI of total MoCA score, 4 patients (7.8%) presented with short-term CD, which persisted at 1 year in 1 patient (2.0%). Four patients (7.8%) exhibited cognitive improvement at 1 year, increasing to 15% among those with baseline cognitive impairment. No significant changes were observed over time in the mean DSST, TMT, and verbal fluency test scores. On the basis of the RCI, 10 of 40 patients (25%) presented with a reduction in performance of at least 1 test at 30 days that persisted at 1 year in 4 patients (10%). CONCLUSIONS TAVR was associated with global improvement in cognitive status, more pronounced among those with cognitive impairment pre-TAVR. However, early decline in some complex cognitive functions was observed in one-quarter of TAVR recipients, persisting at 1 year in 10% of patients.
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Affiliation(s)
- Vincent Auffret
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Ander Regueiro
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - María Del Trigo
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Olivier Chiche
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Chekrallah Chamandi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Ricardo Allende
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Jean-Michel Paradis
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Daniel Doyle
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eric Dumont
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mélanie Côté
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alier Marrero
- Department of Neurology, University Hospital Georges. L. Dumont, Moncton, New Brunswick, Canada
| | - Rishi Puri
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Orkaby AR, Forman DE. Assessing Risks and Benefits of Invasive Cardiac Procedures in Patients with Advanced Multimorbidity. Clin Geriatr Med 2016; 32:359-71. [PMID: 27113152 DOI: 10.1016/j.cger.2016.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Age-related cardiovascular disease in older adults is more likely to occur in combination with other age-related diseases, with mounting interactive complexity as multiple morbidities accumulate. Although invasive cardiac procedures are frequently recommended for cardiovascular disease, their value is less certain in the context of age-related intricacies of care. Tools for risk assessment before invasive procedures are insensitive to risks corresponding to the unique challenges of older adults. Recognizing multimorbidity and other age-related risks provides opportunities to intervene and moderate dangers. By refocusing risk assessment in terms of patient-centered goals, the fundamental utility of invasive cardiac procedures may be reconsidered and alternative therapies prioritized.
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Affiliation(s)
- Ariela R Orkaby
- Division of Cardiology, VA Boston Healthcare System, 400 Veterans of Foreign Wars Pkwy, West Roxbury, MA 02132, USA; Division of Aging, Brigham & Women's Hospital, 1620 Tremont Street, Boston, MA 02120, USA
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA 15213, USA; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University Dr C, Pittsburgh, PA 15240, USA.
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32
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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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