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Ann Thorac Surg 2006;82:388-390
© 2006 The Society of Thoracic Surgeons
a Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
b Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
c Zanvyl Krieger Mind/Brain Institute, Baltimore, Maryland
* Address correspondence to Dr Selnes, Division of Cognitive Neuroscience, Reed Hall East - 2, The Johns Hopkins Hospital, 1620 McElderry St, Baltimore, MD 21205-1910 (Email: oselnes@jhmi.edu).
| The first 300 words of the full text of this article appear below. |
It has been widely assumed that coronary artery bypass grafting (CABG) is associated with cognitive decline. Nevertheless, attempts to quantify these changes with neuropsychological tests have led to highly variable results. For example, the reported incidence of cognitive decline among patients evaluated shortly before hospital discharge has ranged from 14% to a high of 48% [1]. Similar wide variations are reported at later follow-up time points. The source of this variability has been attributed to a variety of factors, including between-study differences in subject selection criteria, postsurgical follow-up times, and the number and sensitivity of neuropsychological tests used to measure cognitive change.
A major limitation of these studies, including our own [2], is that most did not compare the incidence of postoperative cognitive decline among CABG patients to that observed in a control group (ie, either healthy persons or those with similar degrees of cardiovascular and cerebrovascular disease). In the absence of a control group, the criterion for cognitive decline must be based on an arbitrary measure of change within the study population. In early studies, a decline of 1 standard deviation decrease from baseline in 20% of tests was commonly used [3]. More recently a 20% decline in 20% of neuropsychology tests has been used [4]. Mahanna and colleagues [3] applied five such arbitrary criteria for decline to the same data set, and found that the incidence of cognitive decline at 6 weeks after surgery ranged from a low of 1% to a high of 34% depending on which criterion was used [3]. They concluded that the "large variation in the reported incidence of cognitive decline after CABG can be attributed to the different criteria used to define impairment."
Although the findings of Mahanna and colleagues [
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