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Original Articles: Adult Cardiac

The Apolipoprotein E 4 Allele is not Associated With Cognitive Dysfunction in Cardiac Surgery

^a Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
^b Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
^c Department of Pathology, University of Melbourne and the National Neuroscience Facility, Melbourne, Australia

Accepted for publication April 24, 2008.

^_* Address correspondence to Dr Silbert, Department of Anaesthesia, St. Vincent's Health, PO Box 2900, Fitzroy, VIC, 3065, Australia (Email: brendan.silbert{at}svhm.org.au).

Background: The plasma protein apolipoprotein E (APOE) is a risk factor for degenerative cognitive decline manifested by mild cognitive impairment and later by Alzheimer's disease. Patients undergoing coronary artery bypass grafting (CABG) are known to have a high prevalence of preexisting cognitive impairment and postoperative cognitive dysfunction. Because both mild cognitive impairment and Alzheimer's disease generally occur in elderly individuals, the age group that commonly present for CABG, we investigated if the APOE 4 allele was associated with patients manifesting preexisting cognitive impairment and postoperative cognitive dysfunction.

Methods: The DNA of 282 patients who had undergone neuropsychologic testing before and 3 and 12 months after CABG was analyzed for APOE genotype. Patients were classified as having preexisting cognitive impairment if cognitive function was decreased in two or more tests compared with a healthy control group. Postoperative cognitive dysfunction was defined as a decrease in two or more tests compared with the group mean baseline score.

Results: The APOE 4 allele was found in 83 (29.4%) patients. Although preexisting cognitive impairment was present in 105 (37.2%) and postoperative cognitive dysfunction in 33 (12%) and 31 (11%) at 3 and 12 months postoperatively, there was no relationship with the presence of the APOE 4 allele or any of the six genotypes.

Conclusions: Preexisting cognitive impairment and postoperative cognitive dysfunction are not associated with APOE 4 genotype, suggesting that cognitive impairment both before and after CABG may not be associated with degenerative cognitive decline.

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Invited Commentary

Patricia A. Thistlethwaite
Ann. Thorac. Surg. 2008 86: 848. [Extract] [Full Text] [PDF]

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				L. A. Evered, B. S. Silbert, D. A. Scott, P. Maruff, K. M. Laughton, I. Volitakis, T. Cowie, R. A. Cherny, C. L. Masters, and Q.-X. Li Plasma Amyloid beta(42) and Amyloid beta(40) Levels Are Associated With Early Cognitive Dysfunction After Cardiac Surgery. Ann. Thorac. Surg., November 1, 2009; 88(5): 1426 - 1432. [Abstract] [Full Text] [PDF]

				P. A. Thistlethwaite Invited Commentary Ann. Thorac. Surg., September 1, 2008; 86(3): 848 - 848. [Full Text] [PDF]