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Comparison of pre-existing cognitive impairment, amnesic mild cognitive impairment, and multiple domain mild cognitive impairment in men scheduled for coronary artery surgery. Eur J Anaesthesiol 2012 Jul;29(7):320-5

Date

05/10/2012

Pubmed ID

22569024

DOI

10.1097/EJA.0b013e328354223d

Abstract

CONTEXT: Preoperative cognitive impairment (PreCI), amnesic mild cognitive impairment (aMCI; a risk factor for Alzheimer's disease) and multiple domain MCI with amnesia (mdMCI+a) identify preoperative cognitive abnormalities in patients scheduled for coronary artery bypass graft surgery (CABG).

OBJECTIVES: Preoperative cognitive function is important in determining the incidence and severity of postoperative cognitive dysfunction, but the methods used to measure preoperative cognition are diverse. The incidence of preoperative cognitive abnormalities in cardiac surgical patients is unknown.

DESIGN: Observational study.

SETTING: Veteran Administration Medical Center in the United States of America.

PARTICIPANTS: Elective CABG surgery patients and nonsurgical controls.

MAIN OUTCOME MEASURES: Recent verbal and nonverbal memory and executive functions were assessed using psychometric tests. Associations were determined using multivariate regression analysis. We quantified the incidences of PreCI, aMCI and mdMCI+a in patients before elective CABG surgery.

RESULTS: Patients (n = 100) scheduled for surgery had lower cognitive scores compared with nonsurgical controls (n = 100) on eight of 10 psychometric tests. Differences between patients and controls were 'large' for the Immediate and Delayed Story Recall tests (Cohen's d; wherein d is defined as a difference between two means divided by the pooled SD for those two means), 'medium' for the Immediate Word List Recall test and 'small' for five other tests. Twenty-five, 20, and 21 patients satisfied the criteria for PreCI, aMCI and mdMCI+a, respectively. Fifteen patients satisfied the criteria for both PreCI and mdMCI+a, whereas only five did so for both PreCI and aMCI. PreCI was not significantly associated with aMCI (P > 0.05), but was significantly associated with mdMCI+a (P < 0.00001).

CONCLUSION: PreCI, aMCI and mdMCI+a identified preoperative cognitive abnormalities in different groups of patients scheduled for CABG surgery. The findings emphasise that identification of patients with preoperative cognitive dysfunction is methodology-dependent. The optimal approach to subsequently identify patients who may be at greatest risk of progressive cognitive deterioration after CABG surgery remains to be determined.

Author List

Hudetz JA, Patterson KM, Pagel PS

Authors

Paul S. Pagel MD, PhD Professor in the Anesthesiology department at Medical College of Wisconsin
Kathleen M. Patterson PhD Associate Professor in the Psychiatry department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Amnesia
Anesthesia
Cognition
Cognition Disorders
Cognitive Dysfunction
Coronary Artery Bypass
Coronary Vessels
Hospitals, Veterans
Humans
Male
Middle Aged
Multivariate Analysis
Risk
Risk Factors
Treatment Outcome
United States
jenkins-FCD Prod-387 b0ced2662056320369de4e5cd5f21c218c03feb3