Background and Purpose-Improvements in cardiac surgery mortality and morbidity have focused interest on the neurological injury such as stroke and cognitive decline that may accompany an otherwise successful operation. We aimed to investigate (1) the rate of stroke, new ischemic change on MRI, and cognitive impairment after cardiac valve surgery; and (2) the controversial relationship between perioperative cerebral ischemia and cognitive decline. Methods-Forty patients (26 men; mean [SD] age 62.1 [13.7] years) undergoing intracardiac surgery (7 also with coronary artery bypass grafting) were studied. Neurological, neuropsychological, and MRI examinations were performed 24 hours before surgery and 5 days (MRI and neurology) and 6 weeks (neuropsychology and neurology) after surgery. Cognitive decline from baseline was determined using the Reliable Change Index. Results-Two of 40 (5%) patients had perioperative strokes and 22 of 35 (63%) tested had cognitive decline in at least one measure (range, 1 to 4). Sixteen of 37 participants (43%) with postoperative imaging had new ischemic lesions (range, 1 to 17 lesions) with appearances consistent with cerebral embolization. Cognitive decline was seen in all patients with, and 35% of those without, postoperative ischemic lesions (PϽ0.001), and there was an association between the number of abnormal cognitive tests and ischemic burden (PϽ0.001). Conclusion-We have provided a reliable estimate of the rate of stroke, postoperative ischemia, and cognitive impairment at 6 weeks after cardiac valve surgery. Cognitive impairment is associated with perioperative ischemia and is more severe with greater ischemic load.

No abstract

Future simulation may be particularly vulnerable to executive dysfunction in individuals with current/previous depressive symptoms, with evidence of a differential reduction in the specificity of future events. Strategic retrieval abilities were associated with the degree of future event specificity whereas levels of rumination and avoidance were not. Given that the ability to generate specific simulations of the future is associated with enhanced psychological wellbeing, problem solving and coping behaviours, understanding how to increase the specificity of future simulations in depression is an important direction for future research and clinical practice. Interventions focusing on improving the ability to engage strategic processes may be a fruitful avenue for increasing the ability to imagine specific future events in depression. The autobiographical event tasks have somewhat limited ecological validity as they do not account for the many social and environmental cues present in everyday life; the development of more clinically-relevant tasks may be of benefit to this area of study.

No abstract