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Ann Thorac Surg 2007;83:1389-1395
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Postcardiac Surgical Cognitive Impairment in the Aged Using Diffusion-Weighted Magnetic Resonance Imaging

David J. Cook, MDa,*, John Huston, III, MDb, Max R. Trenerry, PhDc, Robert D. Brown, Jr, MDd, Kenton J. Zehr, MDf, Thoralf M. Sundt, III, MDe

a Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota
b Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
c Department of Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota
d Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
e Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
f Division of Cardiac Surgery, University of Pittsburgh Presbyterian Medical Center Pittsburgh, Pennsylvania

Accepted for publication November 28, 2006.

* Address correspondence to Dr Cook, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905 (Email: cook.david{at}mayo.edu).

Background: Cardiac surgery is associated with cerebral dysfunction. While 1% to 2% of patients experience stroke, cognitive deficits are seen in more than half of patients. Given the high incidence of cognitive decline, it has become the endpoint of many cardiac surgery investigations. Because the elderly are at highest risk, this investigation sought to determine if there is a relationship between new ischemic changes demonstrated by diffusion-weighted magnetic resonance imaging (DW-MRI) and postoperative cognitive deficit in older patients.

Methods: Fifty cardiac surgical patients (>65 years of age) underwent preoperative and postoperative neurocognitive examinations, including four to six week, postdischarge, follow-up. This evaluation assessed higher cortical function, memory, attention, concentration, and psychomotor performance. Objective evidence of acute cerebral ischemic events was identified using DW-MRI. Scans were analyzed by a neuroradiologist blinded to clinical status and cognitive outcomes.

Results: Among patients with a mean age of 73 years, 88% demonstrated cognitive decline in the postoperative testing period while 32% showed evidence of acute perioperative cerebral ischemia by DW-MRI. At postdischarge follow-up, 30% of patients showed cognitive impairment. However, cognitive decline assessed postoperatively, or at a four to six week follow-up, was unrelated to the presence or absence of DW-MRI detected cerebral ischemia.

Conclusions: Postoperative neurocognitive impairment, assessed by standard means, is unrelated to acute cerebral ischemia detected by DW-MRI. This strongly suggests that cognitive decline after cardiac surgery is a function of underlying patient factors rather than perioperative ischemic events. This observation has broad implications for future investigation of strategies to prevent cardiac surgery-related neurologic injury.




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