Depression Predicts Delirium After Coronary Artery Bypass Graft Surgery Independent of Cognitive Impairment and Cerebrovascular Disease: An Analysis of the Neuropsychiatric Outcomes After Heart Surgery Study

ABSTRACTBackground:The knowledge base regarding the pathogenesis of postoperative delirium is limited. The primary aim of this study is to investigate whether increased levels of IL-2 and TNF-α are associated with delirium in patients who underwent coronary-artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). The secondary aim is to establish whether any association between raised cytokine levels and delirium is related to surgical and anesthetic procedures or mediated by pre-existing conditions associated with raised cytokine levels, such as major depressive disorder (MDD), cognitive impairment, or aging.Methods:Patients were examined and screened for MDD and cognitive impairment one day preoperatively, using the Mini International Neuropsychiatric Interview and The Montreal Cognitive Assessment and Trail Making Test Part B. Blood samples were collected postoperatively for cytokine levels.Results:Postoperative delirium screening was found positive in 36% (41 of 113) of patients. A multivariate logistic regression revealed that an increased concentration of pro-inflammatory cytokines is associated with delirium, and related to advancing age, preoperative cognitive decline of participants, and duration of CPB. According to receiver operating characteristic analysis, the most optimal cut-off for IL-2 and TNF-α concentrations in predicting the development of delirium were 907.5 U/ml and 10.95 pg/ml, respectively.Conclusions:The present study suggests that raised postoperative cytokine concentrations are associated with delirium after CABG surgery. Postoperative monitoring of pro-inflammatory markers combined with regular surveillance may be helpful in the early detection of postoperative delirium in this patient group.

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Memory loss following coronary artery bypass graft surgery: A discussion of the implications for nursing.

10.32920/ryerson.14669166.v1 ◽

2021 ◽

Author(s):

Suzanne Fredericks

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Heart Surgery ◽

Nursing Practice ◽

Artery Bypass ◽

Bypass Graft ◽

Memory Loss ◽

Common Symptom ◽

Artery Bypass Graft

Aim: The aim of this discursive paper is to present nursing interventions that address memory loss following heart surgery and which can be incorporated into patients’ overall plan of care. Background: Coronary Artery Bypass Graft (CABG) is the most frequent surgical treatment for cardiovascular disease. Despite the advantage, reports indicate CABG procedures significantly increase the risk of cerebral impairment and/or injury which can present itself in the form of memory loss. Older individuals, who tend to be at higher risk for memory loss than other age groups, undergo CABG later in life. Age combined with the effects of the surgical procedure increases the likelihood that individuals over the age of 65 years will experience some form of memory loss following surgery. Method: This discursive paper presented a discussion of the relevance and implications of memory loss to clinical nursing practice with particular attention to strategies nurses should use when caring for patients experiencing this symptom. Relevance to clinical practice: Memory loss is a common symptom present in at least 25% of all patients following CABG. Screening for memory loss following CABG using reliable and valid instruments, revisions to current patient education initiatives to include calling patients following hospital discharge to review education and delivering education over multiple sessions, creating supportive reality-oriented relationships, and engaging in memory oriented training were suggested as nursing strategies that should be incorporated into existing nursing care for patients following CABG. Conclusion: Currently, nursing practice does not routinely incorporate assessment and management of memory loss into the overall plan of care for patients following heart surgery. Specific nursing strategies that centre on the assessment and management of memory loss need to be implemented into standard of nursing practice.

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Cognitive and functional status predictors of delirium and delirium severity after coronary artery bypass graft surgery: an interim analysis of the Neuropsychiatric Outcomes After Heart Surgery study

International Psychogeriatrics ◽

10.1017/s1041610215001477 ◽

2015 ◽

Vol 27 (12) ◽

pp. 1929-1938 ◽

Cited By ~ 19

Author(s):

Mark A. Oldham ◽

Keith A. Hawkins ◽

David D. Yuh ◽

Michael L. Dewar ◽

Umer M. Darr ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Functional Status ◽

Coronary Artery Bypass ◽

Functional Impairment ◽

Heart Surgery ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Cabg Surgery

ABSTRACTBackground:Cognitive and functional impairment increase risk for post-coronary artery bypass graft (CABG) surgery delirium (PCD), but how much impairment is necessary to increase PCD risk remains unclear.Methods:The Neuropsychiatric Outcomes After Heart Surgery (NOAHS) study is a prospective, observational cohort study of participants undergoing elective CABG surgery. Pre-operative cognitive and functional status based on Clinical Dementia Rating (CDR) scale and neuropsychological battery are assessed. We defined mild cognitive impairment (MCI) based on either (1) CDR global score 0.5 (CDR-MCI) or (2) performance 1.5 SD below population means on any cognitive domain on neurocognitive battery (MCI-NC). Delirium was assessed daily post-operative day 2 through discharge using the confusion assessment method (CAM) and delirium index (DI). We investigate whether MCI – either definition – predicts delirium or delirium severity.Results:So far we have assessed 102 participants (mean age 65.1 ± 9; male: 75%) for PCD. Twenty six participants (25%) have MCI-CDR; 38 (62% of those completing neurocognitive testing) met MCI-NC criteria. Fourteen participants (14%) developed PCD. After adjusting for age, sex, comorbidity, and education, MCI-CDR, MMSE, and Lawton IADL score predicted PCD on logistic regression (OR: 5.6, 0.6, and 1.5, respectively); MCI-NC did not (OR [95% CI]: 11.8 [0.9, 151.4]). Using similarly adjusted linear regression, MCI-CDR, MCI-NC, CDR sum of boxes, MMSE, and Lawton IADL score predicted delirium severity (adjusted R2: 0.26, 0.13, 0.21, 0.18, and 0.32, respectively).Conclusions:MCI predicts post-operative delirium and delirium severity, but MCI definition alters these relationships. Cognitive and functional impairment independently predict post-operative delirium and delirium severity.

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Depression predicts cognitive and functional decline one month after coronary artery bypass graft surgery (Neuropsychiatric Outcomes After Heart Surgery study)

International Journal of Geriatric Psychiatry ◽

10.1002/gps.5443 ◽

2020 ◽

Author(s):

Mark A. Oldham ◽

I‐Hsin Lin ◽

Keith A. Hawkins ◽

Fang‐Yong Li ◽

David D. Yuh ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Heart Surgery ◽

Artery Bypass ◽

Bypass Graft ◽

Functional Decline ◽

Artery Bypass Graft

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Memory loss following coronary artery bypass graft surgery: A discussion of the implications for nursing.

10.32920/ryerson.14669166 ◽

2021 ◽

Author(s):

Suzanne Fredericks

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Heart Surgery ◽

Nursing Practice ◽

Artery Bypass ◽

Bypass Graft ◽

Memory Loss ◽

Common Symptom ◽

Artery Bypass Graft

Aim: The aim of this discursive paper is to present nursing interventions that address memory loss following heart surgery and which can be incorporated into patients’ overall plan of care. Background: Coronary Artery Bypass Graft (CABG) is the most frequent surgical treatment for cardiovascular disease. Despite the advantage, reports indicate CABG procedures significantly increase the risk of cerebral impairment and/or injury which can present itself in the form of memory loss. Older individuals, who tend to be at higher risk for memory loss than other age groups, undergo CABG later in life. Age combined with the effects of the surgical procedure increases the likelihood that individuals over the age of 65 years will experience some form of memory loss following surgery. Method: This discursive paper presented a discussion of the relevance and implications of memory loss to clinical nursing practice with particular attention to strategies nurses should use when caring for patients experiencing this symptom. Relevance to clinical practice: Memory loss is a common symptom present in at least 25% of all patients following CABG. Screening for memory loss following CABG using reliable and valid instruments, revisions to current patient education initiatives to include calling patients following hospital discharge to review education and delivering education over multiple sessions, creating supportive reality-oriented relationships, and engaging in memory oriented training were suggested as nursing strategies that should be incorporated into existing nursing care for patients following CABG. Conclusion: Currently, nursing practice does not routinely incorporate assessment and management of memory loss into the overall plan of care for patients following heart surgery. Specific nursing strategies that centre on the assessment and management of memory loss need to be implemented into standard of nursing practice.

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