Self-reported Lifestyle Activities in Relation to Longitudinal Cognitive Trajectories.

Background: Few studies have examined the relationship between lifestyle activity engagement and cognitive trajectories among individuals who were cognitively normal at baseline.

Objective: To examine the relationship of current engagement in lifestyle activities to previous cognitive performance among individuals who were cognitively normal at baseline, and whether this relationship differed for individuals who subsequently developed mild cognitive impairment (MCI), or by APOE-4 genotype, age, and level of cognitive reserve.

Methods: Participants (N=189) were primarily middle-aged (M=56.

Perioperative Low Arterial Oxygenation Is Associated With Increased Stroke Risk in Cardiac Surgery.

Background: Both patient characteristics and intraoperative factors have been associated with a higher risk of stroke after cardiac surgery. We hypothesized that poor systemic oxygenation in the perioperative period is associated with increased risk of stroke following cardiopulmonary bypass.

Methods: In this study of 251 adult patients who underwent cardiopulmonary bypass procedures at a single center from 2003 to 2006, cases (patients with a postoperative stroke at least 24 hours after surgery) were matched 1:2 to controls without stroke.

The BIOCARD Index: A Summary Measure to Predict Onset of Mild Cognitive Impairment.

Background: Changes in neuropsychological testing, neuroimaging, and cerebrospinal fluid may precede mild cognitive impairment (MCI). However, these markers are not routinely performed in outpatient clinical visits.

Objective: To evaluate whether a simple clinical index, consisting of questions given to patients and their informants, could predict the onset of symptoms of MCI among cognitively normal individuals.

Postoperative blood urea nitrogen is associated with stroke in cardiac surgical patients.

Background: This case-control study identified perioperative risk factors associated with postoperative stroke risk after all cardiac surgical procedures.

Methods: Among 5498 adults 18 to 90 years old who underwent cardiac surgical procedures from 2005 to 2010, we identified 180 patients who suffered a stroke within 10 days postoperatively. Controls were randomly selected and frequency matched for sex and age-band to cases.

Cognitive changes preceding clinical symptom onset of mild cognitive impairment and relationship to ApoE genotype.

Background: This study had two goals (1) to evaluate changes in neuropsychological performance among cognitively normal individuals that might precede the onset of clinical symptoms, and (2) to examine the impact of Apolipoprotein E (ApoE) genotype on these changes.

Methods: Longitudinal neuropsychological, clinical assessments and consensus diagnoses were completed prospectively in 268 cognitively normal individuals. The mean duration of follow-up was 9.

Length of red cell unit storage and risk for delirium after cardiac surgery.

Background: The time that red cell units are stored before transfusion may be associated with postoperative complications, although the evidence is conflicting. However, the association between the length of red cell unit storage and postoperative delirium has not been explored. We hypothesized that the length of storage of transfused red cell units would be associated with delirium after cardiac surgery.

The role of head computed tomography imaging in the evaluation of postoperative neurologic deficits in cardiac surgery patients.

Background: Computed tomography (CT) scans of the head without contrast are routinely obtained to evaluate neurologic deficits after cardiac surgery, but their utility is unknown. We evaluated our experience with this imaging modality to determine its value.

Methods: We retrospectively identified cardiac surgery patients with postoperative neurologic deficits occurring during the first week after surgery between January 2000 and December 2012.

Intraoperative hemoglobin levels and transfusion independently predict stroke after cardiac operations.

Background: Anemia has been associated with adverse cerebrovascular outcomes, particularly after cardiac operations. This study was conducted to determine if hemoglobin levels during and after cardiopulmonary bypass (CPB) predict postoperative stroke in cardiac surgical patients, independent of transfusion requirements.

Methods: Individuals who had sustained a clinical postoperative stroke (cases) were matched 1:2 with controls by age, sex, surgical procedure, and year of operation.

Delirium after coronary artery bypass graft surgery and late mortality.

Objective: Delirium is common after cardiac surgery, although under-recognized, and its long-term consequences are likely underestimated. The primary goal of this study was to determine whether patients with delirium after coronary artery bypass graft (CABG) surgery have higher long-term out-of-hospital mortality when compared with CABG patients without delirium.

Methods: We studied 5,034 consecutive patients undergoing CABG surgery at a single institution from 1997 to 2007.

Do management strategies for coronary artery disease influence 6-year cognitive outcomes?

Background: Previous uncontrolled studies have suggested that there is late cognitive decline after coronary artery bypass grafting that may be attributable to use of the cardiopulmonary bypass pump.

Methods: In this prospective, nonrandomized, longitudinal study, we compared cognitive outcomes after on-pump coronary artery bypass surgery (n = 152) with off-pump bypass surgery patients (n = 75); nonsurgical cardiac comparison subjects (n = 99); and 69 heart-healthy comparison (HHC) subjects. The primary outcome measure was change from baseline to 72 months in the following cognitive domains: verbal memory, visual memory, visuoconstruction, language, motor speed, psychomotor speed, attention, executive function, and a composite global score.

Association between hypotension, low ejection fraction and cognitive performance in cardiac patients.

Background And Purpose: Impaired cardiac function can adversely affect the brain via decreased perfusion. The purpose of this study was to determine if cardiac ejection fraction (EF) is associated with cognitive performance, and whether this is modified by low blood pressure.

Methods: Neuropsychological testing evaluating multiple cognitive domains, measurement of mean arterial pressure (MAP), and measurement of EF were performed in 234 individuals with coronary artery disease.

Subjective memory symptoms in surgical and nonsurgical coronary artery patients: 6-year follow-up.

Background: Self-reported cognitive and memory complaints after coronary artery bypass graft (CABG) operations are common. Several studies have attempted to quantify the incidence of such complaints and to examine the relationship between subjective and objective cognitive functioning, but the etiology and longitudinal course of these self-reports remain unclear.

Methods: Measures of subjective memory complaints were compared in two groups: 220 CABG patients and 92 nonsurgical cardiac patients at 3 months, and 1, 3, and 6 years.

Cognition 6 years after surgical or medical therapy for coronary artery disease.

Objective: The choice of coronary artery bypass grafting (CABG) as an intervention for coronary artery disease has been clouded by concerns about postoperative cognitive decline. Long-term cognitive decline after CABG has been reported, but without appropriate control subjects, it is not known whether this decline is specific to CABG or related to other factors such as cerebrovascular disease.

Methods: This prospective, observational study of patients with diagnosed coronary artery disease included 152 CABG and 92 nonsurgical cardiac comparison patients from one institution.

Neurocognitive outcomes 3 years after coronary artery bypass graft surgery: a controlled study.

Background: Cardiopulmonary bypass has been implicated in the late cognitive decline that has been reported after coronary artery bypass graft (CABG) surgery. Because most studies did not include a control group, a causal link of such decline with the use of cardiopulmonary bypass has not been established.

Methods: We compared changes in cognitive performance from baseline to 3 years in patients undergoing on-pump CABG (n = 152) with those of three control groups: patients with off-pump surgery (n = 75); with diagnosed coronary artery disease but no surgery (n = 99); and without coronary artery disease risk factors (n = 69).

Early postoperative cognitive dysfunction and blood pressure during coronary artery bypass graft operation.

Objective: To determine the relationship between change in blood pressure during coronary artery bypass graft operations and early cognitive dysfunction.

Design: Cohort study.

Setting: Quaternary care facility.

Watershed strokes after cardiac surgery: diagnosis, etiology, and outcome.

Background And Purpose: Watershed strokes are more prevalent after cardiac surgery than in other stroke populations, but their mechanism in this setting is not understood. We investigated the role of intraoperative blood pressure in the development of watershed strokes and used MRI to evaluate diagnosis and outcomes associated with this stroke subtype.

Methods: From 1998 to 2003 we studied 98 patients with clinical stroke after cardiac surgery who underwent MRI with diffusion-weighted imaging.

Cognitive and neurobehavioral dysfunction after cardiac bypass procedures.

From a cognitive standpoint, CABG as currently practiced appears to be safe for the great majority of patients, but transient changes involving memory, executive functions, and motor speed may still occur in a subset of patients during the first few days to weeks after CABG. The etiology most likely is multifactorial and includes a synergistic effect of microemboli, hypo-perfusion, and other variables associated with major surgery. Older age and degree of pre-existing cerebrovascular disease have been identified as important risk factors.

Stroke and encephalopathy after cardiac surgery: an update.

Background And Purpose: As a result of advances in surgical, anesthetic, and medical management, cardiac surgery can now be performed on older, sicker patients, some of whom have had prior cardiac interventions. As surgical mortality has declined in recent years, attention has focused on the complications of stroke and encephalopathy after cardiac surgery.

Summary Of Review: Patients with preexisting cerebrovascular disease are at increased risk for these untoward neurological outcomes, which are associated with longer lengths of hospital stay, higher costs, and greater mortality.

Cognitive outcomes three years after coronary artery bypass surgery: a comparison of on-pump coronary artery bypass graft surgery and nonsurgical controls.

Background: Coronary artery bypass grafting has been associated with both early and late postoperative cognitive decline, but interpretation of previous studies has been limited by lack of appropriate control groups. We compared changes in cognitive performance from baseline to 3 years in patients undergoing coronary artery bypass grafting with those of a control group of patients with known risk factors for coronary artery disease but without surgery.

Methods: Patients undergoing coronary artery bypass grafting (n = 140) and a demographically similar nonsurgical control group with coronary artery disease (n = 92) completed baseline neuropsychological assessment and were followed up prospectively at 3, 12, and 36 months.

Quantitative methods for tracking cognitive change 3 years after coronary artery bypass surgery.

The analysis and interpretation of change in cognitive function test scores after coronary artery bypass grafting (CABG) present considerable statistical challenges. Application of hierarchical linear statistical models can estimate the effects of a surgical intervention on the time course of multiple biomarkers. We use an "analyze then summarize" approach whereby we estimate the intervention effects separately for each cognitive test and then pool them, taking appropriate account of their statistical correlations.

Determining the utility of temporary pacing wires after coronary artery bypass surgery.

Background: Temporary epicardial pacing wires are used routinely after coronary artery bypass graft (CABG) surgery and can cause rare, catastrophic complications. This study's purpose was to identify patient characteristics predicting the need for pacing after CABG surgery with the potential to limit their utilization.

Methods: This prospective observational study involved 290 consecutive patients undergoing CABG at our institution from August 2000 to January 2001.

Self-reported memory symptoms with coronary artery disease: a prospective study of CABG patients and nonsurgical controls.

Objective: Subjective memory complaints are common after coronary artery bypass grafting (CABG), but previous studies have concluded that such symptoms are more closely associated with depressed mood than objective cognitive dysfunction. We compared the incidence of self-reported memory symptoms at 3 and 12 months after CABG with that of a control group of patients with comparable risk factors for coronary artery disease but without surgery.

Methods: Patients undergoing CABG (n = 140) and a demographically similar nonsurgical control group with coronary artery disease (n = 92) were followed prospectively at 3 and 12 months.

Mandatory versus selective preoperative carotid screening: a retrospective analysis.

Background: Extracranial internal carotid artery stenosis is a risk factor for perioperative stroke in coronary artery bypass (CAB) surgery. Although both selective and nonselective methods of preoperative carotid screening have been advocated, it is unclear which approach is most clinically efficacious.

Methods: Hospital records for 1421 consecutive CAB patients from January 2000 through April 2002 were reviewed.

Encephalopathy and Stroke After Coronary Artery Bypass Grafting.

Both stroke and encephalopathy are associated with significantly longer lengths of stay in the hospital and with significantly higher rates of mortality. Those at risk for either stroke or encephalopathy, or both of these adverse outcomes after surgery, can be identified prior to surgery using information available to physicians. For those at higher risk for these outcomes, we suggest the following: 1) An imaging study of the brain, performed prior to surgery, may indicate the degree of cerebrovascular disease.