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European Journal of Cardio-Thoracic Surgery, Vol 9, 636-643, Copyright © 1995 by European Association for Cardio-thoracic Surgery
EF Bruggemans, JG Van Dijk and HA Huysmans
Neuropsychological testing is a sensitive method for quantitative
assessment of cognitive dysfunctioning following cardiopulmonary bypass
(CPB). However, the methodological problems associated with this method,
such as learning effects due to repeated testing and the effects of
distress on test performance, have often been underestimated. In this
study, these confounding effects were controlled for by including the
spouses of patients, exposed to the same potential stress effects
associated with the operation, as a nonsurgical control group. The
experimental group consisted of 63 patients (40-75 years) undergoing
elective coronary artery bypass graft (CABG) surgery. A battery of
standardized neuropsychological tests was administered to both groups 2
weeks preoperatively and 1 week, 1 month, and 6 months postoperatively.
Statistical testing of inter-group differences in preoperative to
postoperative changes in test performance revealed the following results:
(1) For immediate memory and learning, in general test scores showed the
same time course for both groups. (2) For recent memory, patients' scores
showed a significant deterioration at 1 month after CABG surgery compared
with the scores of spouses. This effect had not completely disappeared at 6
months postoperatively. (3) For attention and psychomotor speed as well as
verbal fluency, patients' scores had deteriorated significantly at 1 week
after surgery, with incomplete recovery at 6 months. These negative
cognitive effects were not related to the patients' ages or CPB parameters
(duration of CPB, aortic cross-clamp time, mean flow and arterial pressure
during CPB and aortic cross-clamping, and minimum nasopharyngeal
temperature). No differences in self-ratings of mood over time were found
between the patients and spouses. The results indicate that, when
adequately controlling for the effects of learning and distress, some
cognitive functions are still impaired at 6 months after CABG surgery.
ARTICLES
Residual cognitive dysfunctioning at 6 months following coronary artery bypass graft surgery
Department of Cardiothoracic Surgery, University Hospital, Leiden, Netherlands.
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