Coronary artery bypass grafting (CABG) and cognitive decline: a review

Royter, Vladimir; Bornstein, Natan M.; Russell, David

doi:10.1016/j.jns.2004.11.003

Cited by 30 publications

(18 citation statements)

References 19 publications

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“…We showed that procedure-related microemboli was the only predictor of memory decline at one month. Multiple studies on cardiac surgery population have confirmed that postoperative cognitive dysfunction is a significant predictor of long-term cognitive decline 32–35 .…”

Section: Discussionmentioning

confidence: 99%

Prospective neurocognitive evaluation of patients undergoing carotid interventions

Wei

Hitchner

Gillis

et al. 2012

Journal of Vascular Surgery

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OBJECTIVE Distal cerebral embolization is a known complication of carotid interventions. Here we prospectively investigate whether subclinical microembolization seen on post-operative MRI leads to cognitive deficits in a cohort of patients undergoing carotid revascularization procedures. METHODS Patients undergoing carotid interventions and eligible for MRI scanning were recruited to participate. Among 247 patients who received both preoperative and postoperative MRI evaluations, a total of 51 patients also completed neuropsychological testing prior to and at one month following the procedures. Cognitive evaluation included the Rey Auditory Verbal Learning Test (RAVLT) for memory evaluation and the Mini-Mental State Examination (MMSE) for general cognitive impairment screening. RESULTS All 51 patients (16 CAS and 35 CEA) were male with a mean age of 71 years, ranging 54 to 89 years. Among them, 27 patients (53%) were symptomatic preoperatively including 11 patients who had prior stroke and 16 patients who had prior TIA. The majority of the patients had significant medical comorbidities including hypertension (96%), diabetes (31.3%), coronary artery disease (47%), and COPD (15.7%). Two patients (4%) had prior ipsilateral CEA and 8 had contralateral carotid occlusion (15.7%). Memory decline evident on RAVLT was identified in 21 patients including 8 CAS patients and 13 CEA patients. Eleven patients had evidence of procedure-related microemboli. Although there was no significant difference in baseline cognitive function or memory change between CEA and CAS cohort, the CAS cohort had significantly higher incidence of microembolic lesions. Multivariate regression analysis showed that procedure-related microembolization was associated with memory decline (P=0.016) as evident by change in RAVLT. Prior history of neurologic symptom was significantly associated with poor baseline cognitive function (MMSE) (P=0.03) and overall cognitive deterioration (change in MMSE) (P=0.026) as determined by Wilcoxon Rank Sum test and linear regression analysis respectively. CONCLUSIONS Although both CEA and CAS are effective in stroke prevention with minimal neurologic complication, neurocognitive effects remain uncertain. Procedure-associated microembolization and pre-existing neurologic symptoms are associated with poor baseline cognitive function and memory decline following the procedures. Further comprehensive cognitive evaluation to determine the benefit of carotid interventions is warranted.

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Section: Discussionmentioning

confidence: 99%

Prospective neurocognitive evaluation of patients undergoing carotid interventions

Wei

Hitchner

Gillis

et al. 2012

Journal of Vascular Surgery

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“…The development of dysfunction is commonly thought to be multifactorial in nature, however, and there is conflicting evidence for whether there is a more favorable cognitive outcome for those patients who did not require the cardiopulmonary pump during surgery. 32,33 …”

Section: Cognitive Impairment After Hospitalizationmentioning

confidence: 99%

Hospitalization and Cognitive Decline: Can the Nature of the Relationship Be Deciphered?

Mathews¹,

Arnold²,

Epperson³

2014

The American Journal of Geriatric Psychiatry

112

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Background Evidence for a relationship between hospitalization and incident cognitive decline exists mainly in the literature focusing on critical care hospitalization. Recent studies, however, have also found an association between noncritical care hospitalization and the development of cognitive decline. Objective This article will review the literature pertaining to hospitalization and cognitive decline, including hospitalizations for both critical and noncritical care, and in medical and surgical patients. The article will also explore the various factors that have been implicated in the development of cognitive decline and dementia. Methods Review of the literature was completed using PubMed and Medline search programs. Results Several articles supporting evidence for the association between hospitalization and cognitive decline are available. Evidence for potential mediating factors also does exist. Conclusions There is evidence to support an association between hospitalization and development of cognitive decline. Factors that could mediate this association include, but may not be limited to, delirium, medications, stress, and depression. There is a need for further research in this area in order to better understand the underlying pathophysiology involved in the development of cognitive decline and dementia and to determine if preventive measures might be beneficial in decreasing risk for cognitive decline for patients who are hospitalized.

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“…In this group, widespread atherosclerotic disease can predispose to vascular sequele leading to neurological dysfunction. This has been the subject of a recent review (Royter et al 2005). The reported incidence of early cognitive disturbance ranges from 33% to 83%.…”

Section: Risk Factors For Vadmentioning

confidence: 99%

Vascular dementia: prevention and treatment

McVeigh¹,

Passmore²

2006

Clinical Interventions in Aging

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Background:Vascular dementia (VaD) is the most common cause of dementia in the elderly, second only to Alzheimer’s disease (AD). Between 1% and 4% of people of 65 years of age suffer from VaD and the prevalence appears to double every 5–10 years after the age of 65.Summary:Prevention aims to reduce the disease by eliminating its cause or main risk factors, particularly hypertension as well as diabetes mellitus, atherosclerosis, coronary artery disease, smoking, lipid abnormalities, and hyperhomocystinemia. Initial studies of several agents for symptomatic treatment were disappointing. However, there is growing evidence for cholinergic involvement in VaD and recent studies with cholinesterase inhibitors have shown improvement in cognitive, global function, and activities of daily living as compared with placebo and have been well tolerated.Conclusion:VaD is a common condition and its prevalence is likely to increase. As physicians we need to be diligent with regards to recognition of risk factors and vigorous intervention. Promising results have been seen in several clinical trials of cholinesterase inhibitors and no safety of tolerability issues have been noted.

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Coronary artery bypass grafting (CABG) and cognitive decline: a review

Cited by 30 publications

References 19 publications

Prospective neurocognitive evaluation of patients undergoing carotid interventions

Prospective neurocognitive evaluation of patients undergoing carotid interventions

Hospitalization and Cognitive Decline: Can the Nature of the Relationship Be Deciphered?

Vascular dementia: prevention and treatment

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