A population‐based study of the association between coronary artery bypass graft surgery (CABG) and cognitive decline: the Cache County study

Toone, Leslie; Tschanz, JoAnn T.; Corcoran, Christopher; Norton, Maria C.; Zandi, Peter P.; Munger, Ron; Breitner, John C.S.; Welsh‐Bohmer, Kathleen A.

doi:10.1002/gps.1502

Cited by 16 publications

(14 citation statements)

References 30 publications

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“…Post‐pump encephalopathy appears to be a type of vascular dementia resulting from lipid microemboli [167]. This can cause accelerated cognitive decline some years after surgery [179–183]. With ageing, lost capillaries are less likely to be replaced, and this may cause chronic hypoperfusion and exacerbate any bouts of hypoxia.…”

Section: Cerebrovascular Microemboli and Their Clearancementioning

confidence: 99%

“…With ageing, lost capillaries are less likely to be replaced, and this may cause chronic hypoperfusion and exacerbate any bouts of hypoxia. There is an accelerated cognitive decline 5 years after CPB surgery [179–182]. Embolic injury may accelerate age‐related cerebrovascular pathology and reduce vascular reserve and brain reserve.…”

Section: Cerebrovascular Microemboli and Their Clearancementioning

confidence: 99%

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Review: Cerebral microvascular pathology in ageing and neurodegeneration

Brown

Thore²

2011

Neuropathology Appl Neurobio

658

555

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This review of age-related brain microvascular pathologies focuses on topics studied by this laboratory, including anatomy of the blood supply, tortuous vessels, venous collagenosis, capillary remnants, vascular density, and microembolic brain injury. Our studies feature thick sections, large blocks embedded in celloidin, and vascular staining by alkaline phosphatase (AP). This permits study of the vascular network in three dimensions, and the differentiation of afferent from efferent vessels. Current evidence suggests that there is decreased vascular density in aging, Alzheimer’s disease (AD), and leukoaraiosis (LA), and cerebrovascular dysfunction precedes and accompanies cognitive dysfunction and neurodegeneration. A decline in cerebrovascular angiogenesis may inhibit recovery from hypoxia-induced capillary loss. Cerebral blood flow (CBF) is inhibited by tortuous arterioles and deposition of excessive collagen in veins and venules. Misery perfusion due to capillary loss appears to occur before cell loss in LA, and CBF is also reduced in the normal-appearing white matter. Hypoperfusion occurs early in AD, inducing white matter lesions and correlating with dementia. In vascular dementia, cholinergic reductions are correlated with cognitive impairment, and cholinesterase inhibitors have some benefit. Most lipid microemboli from cardiac surgery pass through the brain in a few days, but some remain for weeks. They can cause what appears to be a type of vascular dementia years after surgery. Donepezil has shown some benefit. Emboli, such as clots, cholesterol crystals, and microspheres can be extruded through the walls of cerebral vessels, but there is no evidence yet that lipid emboli undergo such extravasation.

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Section: Cerebrovascular Microemboli and Their Clearancementioning

confidence: 99%

Section: Cerebrovascular Microemboli and Their Clearancementioning

confidence: 99%

Review: Cerebral microvascular pathology in ageing and neurodegeneration

Brown

Thore²

2011

Neuropathology Appl Neurobio

658

555

View full text Add to dashboard Cite

show abstract

“…No significant differences were observed in twins who had CABG later in life 11. However, in another population-based cohort study CABG was associated with global cognitive decline >5 years postoperatively but not in the first 5 years after surgery 12. This suggests that CABG may confer long-term rather than short-term risk of cognitive decline, and by implication may increase the risk of dementia.…”

mentioning

confidence: 94%

Coronary Artery Bypass Graft Surgery and Dementia Risk in the Cardiovascular Health Study

Kuźma

Airdrie

Littlejohns

et al. 2017

Alzheimer Disease &Amp; Associated Disorders

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“…That proportion went down to 24% at 6 months after surgery, but came back up to 42% at 5 years after surgery-a pattern of early improvement followed by subsequent decline that was predicted by POCD at discharge. 94 …”

Section: Postoperative Cognitive Dysfunction After Noncardiac Surgerymentioning

confidence: 99%

Developmental Disability in the Young and Postoperative Cognitive Dysfunction in the Elderly After Anesthesia and Surgery: Do Data Justify Changing Clinical Practice?

Cottrell

Hartung

2012

Mount Sinai J Medicine

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The assumption that anesthesia has no serious, long‐term, adverse central nervous system consequences may be true for most patients between 6 months and 60 years of age. However, for patients younger than 6 months or older than 60 years, that status quo assumption is under challenge from a growing body of evidence. Fetuses and newborns appear to be at risk because systems that would enable them to fully recover from the effects of more than 2 hours of anesthesia are still in development. In distinction, the elderly appear to be at risk because systems that once enabled them to fully recover have ever‐diminishing capacity. Even for those between the age of 6 months and 60 years, full recovery may require replacing apoptosed neurons and pruning overabundant dendritic spines … perhaps leaving patients not quite the same person that they were before they were anesthetized. Mt Sinai J Med 79:75–94, 2012. © 2012 Mount Sinai School of Medicine

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A population‐based study of the association between coronary artery bypass graft surgery (CABG) and cognitive decline: the Cache County study

Cited by 16 publications

References 30 publications

Review: Cerebral microvascular pathology in ageing and neurodegeneration

Review: Cerebral microvascular pathology in ageing and neurodegeneration

Coronary Artery Bypass Graft Surgery and Dementia Risk in the Cardiovascular Health Study

Developmental Disability in the Young and Postoperative Cognitive Dysfunction in the Elderly After Anesthesia and Surgery: Do Data Justify Changing Clinical Practice?

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