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Ann Thorac Surg 1997;64:715-720
© 1997 The Society of Thoracic Surgeons

Original Article: Cardiovascular

Preliminary Report of a Genetic Basis for Cognitive Decline After Cardiac Operations

Barbara E. Tardiff, MD, Mark F. Newman, MD, Ann M. Saunders, PhD, Warren J. Strittmatter, MD, James A. Blumenthal, PhD, William D. White, MPH, Narda D. Croughwell, CRNA, R. Duane Davis, Jr, MD, Allen D. Roses, MD, Joseph G. Reves, MD and the Neurologic Outcome Research Group of the Duke Heart Center

Division of Cardiac Anesthesia, Department of Anesthesiology, Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Division of Neurology, Department of Medicine, Department of Neurobiology, Department of Psychiatry, and Department of Surgery, Duke University Medical Center, Durham, North Carolina

Accepted for publication June 30, 1997.

Background. Changes in memory and cognition frequently follow cardiac operations. We hypothesized that patients with the apolipoprotein E-{epsilon}4 allele are genetically predisposed to cognitive dysfunction after cardiac operations.

Methods. The apolipoprotein E-{epsilon}4 allele was evaluated as a predictor variable for postoperative cognitive dysfunction in 65 patients undergoing cardiac bypass grafting at Duke University Medical Center. The primary outcome measure was performance on a cognitive battery administered preoperatively and at 6 weeks postoperatively.

Results. In a multivariable logistic regression analysis including apolipoprotein E-{epsilon}4, preoperative score, age, and years of education, a significant association was found between apolipoprotein E-{epsilon}4 and change in cognitive test score in measures of short-term memory at 6 weeks postoperatively. Patients with lower educational levels were more likely to show a decline in cognitive function associated with the apolipoprotein E-{epsilon}4 allele.

Conclusions. This study suggests that apolipoprotein E genotype is related to cognitive dysfunction after cardiopulmonary bypass. Cardiac surgical patients may be susceptible to deterioration after physiologic stress as a result of impaired genetically determined neuronal mechanisms of maintenance and repair.




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Genetic Predictors of Perioperative Neurologic and Neuropsychological Injury and Recovery
Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1999; 3(1): 34 - 46.
[Abstract] [PDF]

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 Am. J. Pathol.Home page
P.-T. Xu, J. R. Gilbert, H.-L. Qiu, J. Ervin, T. R. Rothrock-Christian, C. Hulette, and D. E. Schmechel
Specific Regional Transcription of Apolipoprotein E in Human Brain Neurons
Am. J. Pathol., February 1, 1999; 154(2): 601 - 611.
[Abstract] [Full Text] [PDF]

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 J. Neurosci.Home page
Y. Sun, S. Wu, G. Bu, M. K. Onifade, S. N. Patel, M. J. LaDu, A. M. Fagan, and D. M. Holtzman
Glial Fibrillary Acidic Protein-Apolipoprotein E (apoE) Transgenic Mice: Astrocyte-Specific Expression and Differing Biological Effects of Astrocyte-Secreted apoE3 and apoE4 Lipoproteins
J. Neurosci., May 1, 1998; 18(9): 3261 - 3272.
[Abstract] [Full Text] [PDF]


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