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Ann Thorac Surg 2007;83:374-376
© 2007 The Society of Thoracic Surgeons

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Editorials

Coronary Artery Bypass Grafting Baseline Cognitive Assessment: Essential Not Optional

^a Department of Neurology, The Johns Hopkins University School of Medicine
^b Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health

^_* Address correspondence to Dr Selnes, Division of Cognitive Neuroscience, Johns Hopkins Medical Institutions, Read Hall–East 2, Baltimore, MD 21205-1910 (Email: oselnes@jhmi.edu).

The first 300 words of the full text of this article appear below.

An important clinical as well as research use of neuropsychological testing is to evaluate changes in cognitive performance over time. Prospective follow-up studies allow identification of changes in the progression of a disease, recovery, and possible effects of pharmacological interventions. In the context of cardiac surgery, preoperative baseline testing followed by one or more postoperative assessments has become an established method for evaluating the possible impact of the use of cardiopulmonary bypass on cognitive outcomes.

However, it is well known that the reported incidence of cognitive decline after coronary artery bypass grafting (CABG) has varied quite significantly from one study to another. It has been widely assumed that this variability has resulted from differences in patient populations, follow-up time intervals, and the choice of neuropsychological measures. More recently it has become apparent that even more important factors contributing to variability in the estimates of rates of postoperative CABG cognitive decline are the choice of statistical criteria for defining decline and the inclusion of control groups. One of the most noteworthy examples of the importance of these factors is the Octopus Study in which the reported incidence of postoperative cognitive decline changed dramatically from 31% to 8% after a different criterion for decline and inclusion of control subjects was applied [1].

In this issue of The Annals of Thoracic Surgery, Keith and colleagues [2] draw attention to another potential methodological shortcoming in the assessment of cognitive changes after CABG. They note that the preoperative baseline evaluation may be unreliable because of situational and patient-related variables. This, together with practice effects from repeated exposure to the same neuropsychological tests, can lead to an underestimate of the degree of cognitive change associated with the use of cardiopulmonary bypass. They argue that the use of a control group can . . . [Full Text of this Article]

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Why Serial Assessments of Cardiac Surgery Patients’ Neurobehavioral Performances are Misleading

Julian R. Keith, Dale J. Cohen, and Len B. Lecci
Ann. Thorac. Surg. 2007 83: 370-373. [Extract] [Full Text] [PDF]