Prospective assessment of the impact of cardiac surgery on cognitive function

2019 ◽  
Vol 405 ◽  
pp. 110
Author(s):  
P. Reddy ◽  
A.O. Saroja ◽  
K.R. Naik ◽  
R. Saldanha
Keyword(s):  
Cardiac Surgery ◽  
Cognitive Function ◽  
Prospective Assessment ◽  
The Impact

scholarly journals Effects of Extreme Hemodilution during Cardiac Surgery on Cognitive Function in the Elderly

2007 ◽  
Vol 107 (4) ◽  
pp. 577-584 ◽  
Author(s):  
Joseph P. Mathew ◽  
G Burkhard Mackensen ◽  
Barbara Phillips-Bute ◽  
Mark Stafford-Smith ◽  
Mihai V. Podgoreanu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cognitive Function ◽  
Adverse Events ◽  
Older Patients ◽  
Artery Bypass ◽  
Randomized Study ◽  
Multivariable Analysis ◽  
Neurocognitive Deficits ◽  
The Impact

Background Strategies for neuroprotection including hypothermia and hemodilution have been routinely practiced since the inception of cardiopulmonary bypass. Yet postoperative neurocognitive deficits that diminish the quality of life of cardiac surgery patients are frequent. Because there is uncertainty regarding the impact of hemodilution on perioperative organ function, the authors hypothesized that extreme hemodilution during cardiac surgery would increase the frequency and severity of postoperative neurocognitive deficits. Methods Patients undergoing coronary artery bypass grafting surgery were randomly assigned to either moderate hemodilution (hematocrit on cardiopulmonary bypass >or=27%) or profound hemodilution (hematocrit on cardiopulmonary bypass of 15-18%). Cognitive function was measured preoperatively and 6 weeks postoperatively. The effect of hemodilution on postoperative cognition was tested using multivariable modeling accounting for age, years of education, and baseline levels of cognition. Results After randomization of 108 patients, the trial was terminated by the Data Safety and Monitoring Board due to the significant occurrence of adverse events, which primarily involved pulmonary complications in the moderate hemodilution group. Multivariable analysis revealed an interaction between hemodilution and age wherein older patients in the profound hemodilution group experienced greater neurocognitive decline (P = 0.03). Conclusions In this prospective, randomized study of hemodilution during cardiac surgery with cardiopulmonary bypass in adults, the authors report an early termination of the study because of an increase in adverse events. They also observed greater neurocognitive impairment among older patients receiving extreme hemodilution.

The impact of protocolized communication during cardiac surgery

2009 ◽  
Author(s):  
S. Henrickson Parker ◽  
R. Wadhera ◽  
D. Wiegmann ◽  
T. M. Sundt
Keyword(s):  
Cardiac Surgery ◽  
The Impact

The Oxford Handbook of Adult Cognitive Disorders

2019 ◽  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Neurodevelopmental Disorders ◽  
Brain Aging ◽  
Cognitive Disorders ◽  
Diverse Range ◽  
Medical Specialties ◽  
Psychiatric Illnesses ◽  
Medical Disorders ◽  
The Impact

The prevalence of cognitive impairment caused by neurodegenerative diseases and other neurologic disorders associated with aging is expected to rise dramatically between now and year 2050, when the population of Americans aged 65 or older will nearly double. Cognitive impairment also commonly occurs in other neurologic conditions, as well as in non-neurologic medical disorders (and their treatments), idiopathic psychiatric illnesses, and adult neurodevelopmental disorders. Cognitive impairment can thus infiltrate all aspects of healthcare, making it necessary for clinicians and clinical researchers to have an integrated knowledge of the spectrum of adult cognitive disorders. The Oxford Handbook of Adult Cognitive Disorders is meant to serve as an up-to-date, scholarly, and comprehensive volume covering most diseases, conditions, and injuries resulting in impairments in cognitive function in adults. Topics covered include normal cognitive and brain aging, the impact of medical disorders (e.g., cardiovascular, liver, pulmonary) and psychiatric illnesses (e.g., depression and bipolar disorder) on cognitive function, adult neurodevelopmental disorders (e.g., Down Syndrome, Attention Deficit/Hyperactivity Disorder), as well as the various neurological conditions (e.g., Alzheimer’s disease, chronic traumatic encephalopathy, concussion). A section of the Handbook is also dedicated to unique perspectives and special considerations for the clinicians and clinical researchers, covering topics such as cognitive reserve, genetics, diversity, and neuroethics. The target audience of this Handbook includes: (1) clinicians, particularly psychologists, neuropsychologists, neurologists (including behavioral and cognitive neurologists), geriatricians, and psychiatrists (including neuropsychiatrists), who provide clinical care and management for adults with a diverse range of cognitive disorders; (2) clinical researchers who investigate cognitive outcomes and functioning in adult populations; and (3) graduate level students and post-doctoral trainees studying psychology, clinical neuroscience, and various medical specialties.

scholarly journals Effect of the Information Support Robot on the Daily Activity of Older People Living Alone in Actual Living Environment

2021 ◽  
Vol 18 (5) ◽  
pp. 2498
Author(s):  
Jumpei Mizuno ◽  
Daisuke Saito ◽  
Ken Sadohara ◽  
Misato Nihei ◽  
Shinichi Ohnaka ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Older People ◽  
Daily Activity ◽  
Living Environment ◽  
Living Alone ◽  
Information Support ◽  
Sleep Patterns ◽  
High Cognitive Function ◽  
Environment Study ◽  
The Impact

Information support robots (ISRs) have the potential to assist older people living alone to have an independent life. However, the effects of ISRs on the daily activity, especially the sleep patterns, of older people have not been clarified; moreover, it is unclear whether the effects of ISRs depend on the levels of cognitive function. To investigate these effects, we introduced an ISR into the actual living environment and then quantified induced changes according to the levels of cognitive function. Older people who maintained their cognitive function demonstrated the following behavioral changes after using the ISR: faster wake-up times, reduced sleep duration, and increased amount of activity in the daytime (p < 0.05, r = 0.77; p < 0.05, r = 0.89, and p < 0.1, r = 0.70, respectively). The results suggest that the ISR is beneficial in supporting the independence of older people living alone since living alone is associated with disturbed sleep patterns and low physical activity. The impact of the ISR on daily activity was more remarkable in the subjects with high cognitive function than in those with low cognitive function. These findings suggest that cognitive function is useful information in the ISR adaptation process. The present study has more solid external validity than that of a controlled environment study since it was done in a personal residential space.

The impact of exogenous nitric oxide during cardiopulmonary bypass for cardiac surgery

Perfusion ◽  
2021 ◽  
pp. 026765912110148
Author(s):  
Joseph Mc Loughlin ◽  
Lorraine Browne ◽  
John Hinchion
Keyword(s):  
Nitric Oxide ◽  
Systematic Review ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Troponin I ◽  
Length Of Hospital Stay ◽  
Cochrane Library ◽  
High Quality Research ◽  
Low Cardiac Output Syndrome ◽  
The Impact

Objectives: Cardiac surgery using cardiopulmonary bypass frequently provokes a systemic inflammatory response syndrome. This can lead to the development of low cardiac output syndrome (LCOS). Both of these can affect morbidity and mortality. This study is a systematic review of the impact of gaseous nitric oxide (gNO), delivered via the cardiopulmonary bypass (CPB) circuit during cardiac surgery, on post-operative outcomes. It aims to summarise the evidence available, to assess the effectiveness of gNO via the CPB circuit on outcomes, and highlight areas of further research needed to develop this hypothesis. Methods: A comprehensive search of Pubmed, Embase, Web of Science and the Cochrane Library was performed in May 2020. Only randomised control trials (RCTs) were considered. Results: Three studies were identified with a total of 274 patients. There was variation in the outcomes measures used across the studies. These studies demonstrate there is evidence that this intervention may contribute towards cardioprotection. Significant reductions in cardiac troponin I (cTnI) levels and lower vasoactive inotrope scores were seen in intervention groups. A high degree of heterogeneity between the studies exists. Meta-analysis of the duration of mechanical ventilation, length of ICU stay and length of hospital stay showed no significant differences. Conclusion: This systematic review explored the findings of three pilot RCTs. Overall the hypothesis that NO delivered via the CPB circuit can provide cardioprotection has been supported by this study. There remains a significant gap in the evidence, further high-quality research is required in both the adult and paediatric populations.

scholarly journals Risk of Nursing Home Use Among Older Americans: The Impact of Psychiatric History and Trajectories of Cognitive Function

2021 ◽  
Author(s):  
Maria T Brown ◽  
Miriam Mutambudzi
Keyword(s):  
Nursing Home ◽  
Cognitive Function ◽  
Latent Class ◽  
Study Data ◽  
Psychiatric Training ◽  
Psychiatric History ◽  
Term Care ◽  
Increased Risk ◽  
Course Variables ◽  
The Impact

Abstract Objectives Mental illness and cognitive functioning may be independently associated with nursing home use. We investigated the strength of the association between baseline (1998) psychiatric history, 8-year cognitive function trajectories, and prospective incidence of nursing home use over a 10-year period while accounting for relevant covariates in U.S. adults aged 65 and older. We hypothesized that self-reported baseline history of psychiatric, emotional, or nervous problems would be associated with a greater risk of nursing home use and that cognition trajectories with the greatest decline would be associated with a subsequent higher risk of nursing home use. Methods We used 8 waves (1998–2016) of Health and Retirement Study data for adults aged 65 years and older. Latent class mixture modeling identified 4 distinct cognitive function trajectory classes (1998–2006): low-declining, medium-declining, medium-stable, and high-declining. Participants from the 1998 wave (N = 5,628) were classified into these 4 classes. Competing risks regression analysis modeled the subhazard ratio of nursing home use between 2006 and 2016 as a function of baseline psychiatric history and cognitive function trajectories. Results Psychiatric history was independently associated with greater risk of nursing home use (subhazard ratio [SHR] 1.26, 95% confidence interval [CI] 1.06–1.51, p &lt; .01), net the effects of life course variables. Furthermore, “low-declining” (SHR 2.255, 95% CI 1.70–2.99, p &lt; .001) and “medium-declining” (2.103, 95% CI 1.69–2.61, p &lt; .001) trajectories predicted increased risk of nursing home use. Discussion Evidence of these associations can be used to educate policymakers and providers about the need for appropriate psychiatric training for staff in community-based and residential long-term care programs.

scholarly journals The beneficial effects of physical preoperative and postoperative training for the cognitive function in cardiosurgical patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O Trubnikova ◽  
I Tarasova ◽  
E Moskin ◽  
Y Argunova ◽  
D Kupriyanova ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cognitive Function ◽  
Physical Training ◽  
Training Group ◽  
Aerobic Exercise Training ◽  
Funding Source ◽  
Beneficial Effects ◽  
Preoperative Training ◽  
Cabg Patients ◽  
Cycling Training

Abstract Background and aim The cardiac surgery patients have an increased risk of postoperative cognitive dysfunction (POCD). The positive healing effects of physical exercise was demonstrated early in patients with cognitive impairment. The aim of the study was to evaluate the effect of physical preoperative and postoperative training for the cognitive function in patients undergoing on-pump coronary artery bypass grafting (CABG). Methods We analyzed the neurophysiological data from 125 male coronary artery disease (CAD) patients who participated in two sub-studies: the patients with a short preoperative course of treadmill training (n=33) and with postoperative aerobic exercise training (n=92). The study of preoperative physical training included CABG-candidates, which were divided into 2 groups: with (n=17) and without training (n=16). The preoperative physical training consisted of a 5–7 day course of intensive training on a treadmill. The study with postoperative aerobic exercise training enrolled CAD patients, undergoing on-pump CABG, which were divided into 2 groups: with supervised cycling training (n=39) and without training (n=53). Three-week trainings course began on the 14-th day after CABG. The patients with and without preoperative and postoperative physical training were comparable in terms of preoperative characteristics and intraoperative parameters. The patients were underwent the neuropsychological and EEG examination to assess postoperative changes in neurophysiological performance. Results The patients with preoperative treadmill training had the POCD incidence at 7–10 days after GABG in 44% cases vs. 74% - in the group without training. The relative risk of POCD developing in the patients with preoperative training was: OR=0.24, 95% CI: 0.07–0.81, Z=2.297, p=0.02. Additionally, the patients with preoperative training demonstrated a lower power in the theta (4–6 Hz) and beta1 (13–20 Hz) frequency ranges 7–10 days after CABG. The patients with postoperative cycling training also demonstrated better cognitive function at 1 month after CABG compared to the patients without training. The incidence of POCD was 21% in the cycling training group vs. 44% – in the group without training. The relative risk of POCD developing was: OR=0.23, 95% CI: 0.09–0.60, Z=3.041, p=0.0024. Also, it was found that the postoperative cycling training group showed a lower percentage theta power increase at 1 month after CABG. Conclusion Both the short preoperative and three-week postoperative physical training course can produce beneficial effects on the postoperative neurophysiological status in CABG patients. The engagement of physical training in the rehabilitation program of CABG patients can improve cognitive functioning after cardiac surgery. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): RFBR and Kemerovskaya region

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