Several studies have demonstrated that a sizeable proportion of patients undergoing coronary artery bypass graft (CABG) demonstrate persistent declines in cognitive functioning. However, several important questions remain regarding cognitive changes following CABG. First, can patients vulnerable to cognitive decline after CABG be identified, providing valuable information that can be factored into clinical decisions? Second, the specificity of CABG as a cause of cognitive decline, when compared to other coronary procedures such as percutaneous coronary interventions, has not been established. Third, what mechanisms account for the neurocognitive decline after CABG? Several mechanisms have been proposed to lead to post-CABG neurocognitive deficits, including pre-CABG neurocognitive deficits, physiological injury, psychosocial factors, and/or the patient’s perceptual processes. Finally, no study has demonstrated that cognitive changes, as measured by neuropsychological tests, have ecological validity. Specifically, behavioral sciences research is needed to demonstrate that measured cognitive changes significantly impact health status independent of other risk factors.
Get full access to this article
View all access options for this article.
References
1.
AHA . (2000). 2001 heart and stroke statistical update. Dallas, TX: Author.
2.
AHA. (2001). Atherosclerosis. Retrieved December 15, 2001, from http://www.americanheart.org/presenter.jhtml?identifier=4440
3.
Ali, M. S. , Harmer, M., & Vaughan, R. (2000). Serum S100 protein as a marker of cerebral damage during cardiac surgery. British Journal of Anaesthesia, 85, 287-298.
4.
Allan, R. , & Scheidt, S. (1996). Heart and mind: The practice of cardiac psychology. Washington, DC: American Psychological Association.
5.
Bovowic, L. M. , Goldsborough, M. A., Selnes, O. A., & McKhann, G. M. (1996). Neuropsychologic change following cardiac surgery: A critical review. Journal of Cardiothoracic Vascularization and Anesthesia, 10, 105-112.
6.
Broadbent, D. E. , Copper, P. F., Fitzgerald, P., & Parkes, K. R. (1982). The Cognitive Failures Questionnaire (CFQ) and its correlates. The British Psychological Society, 221, 1-16.
7.
Cammermeyer, M. , & Evans, J. E. (1989). A brief neurobehavioral exam useful for early detection of postoperative complications in neurosurgical patients. Journal of Neuroscience Nursing, 20, 153-160.
8.
Chapman, J. , Vinokurov, S., Achiron, A., Karussis, D. M., Mitosek-Szewczyk, K., Birnbaum, M., et al. (2001). APOE genotype is a major predictor of long-term progression of disability in MS. Neurology, 56, 312-316.
9.
Cheitlin, M. D. , Gerstenblith, G., Hazzard, W. R., Pasternak, R., Fried, L. P., & Rich, M. W., et al. (2001). Do existing databases answer clinical questions about geriatric cardiovascular disease and stroke?The American Journal of Geriatric Cardiology, 10, 207-224.
10.
Corder, E. H. , Saunders, A. M., Strittmatter, W. J., Schemechel, D. E., Gaskell, P. C., Small, G. W., et al. (1993). Gene dose of the apolipoprotein ε type 4 allele and the risk of Alzheimer’s disease in late onset families. Science, 261, 921-923.
11.
Dougherty, C. M. , Dewhurst, T., Nichol, W. P., & Spertus, J. (1998). Comparison of three quality of life instruments in stable angina pectoris: Seattle Angina Questionnaire, Short Form Health Survey (SF-36), and Quality of Life Index–Cardiac Version III. Journal of Clinical Epidemiology, 51, 569-575.
12.
Elting, J. W. , de Jager, A. E., Teelken, A. W., Schaaf, M. J., Maurits, N. M., van der Naalt, J., et al. (2000). Comparison of serum S-100 protein levels following stroke and traumatic brain injury. Journal of Neurological Sciences, 181, 104-110.
13.
Engle, K. A. , Guyton, R. A., Davidoff, R., Ewy, G. A., Fonger, J., Gardner, T. J., et al. (1999). ACC/AHA guidelines for coronary artery bypass graft surgery: Executive summary and recommendations. Circulation, 100, 1464-1480.
14.
Georgiadis, D. , Berger, A., Kowatschev, E., Lautenschlager, C., Borner, A., Linder, A., et al. (2000). Predictive value of S-100 beta and neuron-specific enolase serum levels for adverse neurologic outcome after cardiac surgery. Journal of Thoracic and Cardiovascular Surgery, 119, 138-147.
15.
Goss, J. R. , Whitten, R. W., Phillips, R. C., Johnston, G. G., Hofer, B. O., Mansfield, P. B., et al. (2000). Washington state’s model of physician leadership in cardiac outcomes reporting. Annals of Thoracic Surgery, 70, 695-701.
16.
Guyatt, G. H. , Feeny, D. H., & Patrick, D. L. (1993). Measuring health-related quality of life. Annals of Internal Medicine, 118, 622-629.
17.
Jones, R. H. , Hannan, E. L., Hammermeister, K. E., DeLong, E. R., O’Connor, G. T., Leupker, R. V., et al. (1996). Identification of preoperative variables needed for risk adjustment in short-term mortality after coronary artery bypass graft surgery. Journal of the American College of Cardiology, 28, 1478-1487.
18.
Jonsson, H. , Johnsson, P., Alling, C., Westaby, S., & Blomquist, S. (1998). Significance of serum S100 release after coronary artery bypass grafting. Annals of Thoracic Surgery, 65, 1639-1644.
19.
Kilminster, S. , Treasure, T., McMillan, T., & Holt, D. W. (1999). Neuropsychological change and S-100 protein release in 130 unselected patients undergoing cardiac surgery. Stroke, 30, 1869-1874.
20.
McKhann, G. M. , Borowicz, L. M., Goldsborough, M. A., Enger, C., & Selnes, O. A. (1997). Depression and cognitive decline after coronary artery bypass grafting. Lancet, 349, 1282-1284.
21.
Newman, M. F. , Croughwell, N. D., Blumenthal, J. A., Lowry, E., White, W. D., Spillane, W., et al. (1995). Predictors of cognitive decline after cardiac operation. Annals of Thoracic Surgery, 59, 1326-1330.
22.
Newman, M. F. , Kirchner, J. L., Phillips-Bute, B., Gaver, V., Grocott, H., Jones, R. H., et al. (2001). Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. New England Journal of Medicine, 344, 395-402.
23.
Niskakangas, T. , Ohman, J., Niemela, M., Ilveskoski, E., Kunnas, T. A., & Karhunen, P. J. (2001). Association of apolipoprotein ε polymorphism with outcome after aneurismal subarachnoid hemorrhage: A preliminary study. Stroke, 32, 1181-1181.
24.
Rasmussen, L. S. , Christiansen, M., Hansen, P. B., & Moller, J. T. (1999). Do blood levels of neuron-specific enolase and S-100 protein reflect cognitive dysfunction after coronary artery bypass?Acta Anaesthesiologica scandinavica, 43, 495-500.
25.
Rodig, G. , Rak, A., Kasprzak, P., & Hobbhahn, J. (1999). Evaluation of self-reported failures in cognitive function after cardiac and noncardiac surgery. Anaesthesia, 54, 826-830.
26.
Selnes, O. A. , Goldsborough, M. A., Borowicz, L. M., & McKhann, G. M. (1999a). Neurobehavioural sequelae of cardiopulmonary bypass. Lancet, 353, 1601-1606.
27.
Selnes, O. A. , Goldsborough, M. A., Borowicz, L. M., Enger, C., Quaskey, S. A., & McKhann, G. M. (1999b). Determinants of cognitive change after coronary artery bypass surgery: A multifactorial problem. Annals of Thoracic Surgery, 67, 1669-1676.
28.
Selnes, O. A. , Royall, R. M., Grega, M. A., Borowicz, L. M., Quaskey, S., & McKhann, G. M. (2001). Cognitive changes 5 years after coronary artery bypass grafting: Is there evidence of late decline?Archives of Neurology, 58, 598-604.
29.
Smith, M. H. , Wagenknecht, L. F., Legault, C., Goff, D. C., Stump, D. A., Troost, B. T., et al. (2000). Age and other risk factors for neuropsychologic decline in patients undergoing coronary artery bypass graft surgery. Journal of Cardiothoracic and Vascular Anesthesia, 14, 428-432.
30.
Taggart, D. P. , Browne, S. M., Halligan, P. W., & Wade, D. T. (1999). Is cardiopulmonary bypass still the cause of cognitive dysfunction after cardiac operations?Journal of Thoracic and Cardiovascular Surgery, 118, 414-421.
31.
Taggart, D. P. , Mazel, J. W., Bhattacharya, K., Metson, N., Standing, S. J., Kay, J. D., et al. (1997). Comparison of serum S-100 beta levels during CABG and intracardiac operations. Annals of Thoracic Surgery, 63(2), 492-496.
32.
Tardiff, B. E. , Newman, M. F., Saunders, A. M., Strittmatter, W. J., Blumenthal, J. A., White, W. D., et al. (1997). Preliminary report of a genetic basis for cognitive decline after cardiac operations. Annals of Thoracic Surgery, 64, 715-720.
33.
Ti, L. K. , Mathew, J. P., Mackensen, G. B., Grocott, H. P., White, W. D., Reves, J. G., et al. (2000). Effect of apolipoprotein ε genotype on cerebral autoregularion during cardiopulmonary bypass. Stroke, 32, 1514-1514.
34.
Vingerhoets, G. , Van Nooten, G., & Jaanes, C. (1997). Neuropsychological impairment in candidates for cardiac surgery. Journal of the International Neuropsychological Society, 3, 480-484.
35.
Westaby, S. , Johnsson, P., Parry, A., Blomquist, S., Solem, J. O., Alling, C., et al. (1996). Serum S100 protein: A potential marker for cerebral events during cardiopulmonary bypass. Annals of Thoracic Surgery, 61, 88-92.
36.
Wilson, B. A. (1993). Ecological validity of neuropsychological assessment: Do neuropsychological indexes predict performance in everyday activities?Applied and Preventive Psychology, 2, 209-215.
37.
Yasuda, M. , Mori, E., Kitagaki, H., Yamashita, H., Hirono, N., Shimada, K., et al. (1998). Apolipoprotein ε 4 allele and whole brain atrophy in late-onset Alzheimer’s disease. American Journal of Psychiatry, 155, 779-784.
