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Neuropsychological Function After Coronary Artery Bypass Grafting

Dautovic Bergh, Cecilia LU (2007) In The Annals of Thoracic Surgery; Scandinavian Cardiovascular Journal
Abstract (Swedish)
Popular Abstract in Swedish

Trots omfattande forskning är förståelsen för diffus hjärnpåverkan efter hjärtkirurgi och dess kliniska betydelse ofullständig. Avhandlingens syfte har varit att kartlägga kognitiv funktion efter kranskärlskirurgi och undersöka de kliniska konsekvenserna därav.



Med neuropsykologiska test, intervjuer och frågeformulär har patienters subjektiva och objektiva kognitiva funktionsnivå efter kranskärlskirurgi mätts. Äggviteämnet S100B har också prövats som markör för hjärnpåverkan, dödlighet, neuropsykologiska testresultat och emotionellt välbefinnande.



Resultaten visar att



1. Valet av statistisk definition och neuropsykologiska metoder är... (More)
Popular Abstract in Swedish

Trots omfattande forskning är förståelsen för diffus hjärnpåverkan efter hjärtkirurgi och dess kliniska betydelse ofullständig. Avhandlingens syfte har varit att kartlägga kognitiv funktion efter kranskärlskirurgi och undersöka de kliniska konsekvenserna därav.



Med neuropsykologiska test, intervjuer och frågeformulär har patienters subjektiva och objektiva kognitiva funktionsnivå efter kranskärlskirurgi mätts. Äggviteämnet S100B har också prövats som markör för hjärnpåverkan, dödlighet, neuropsykologiska testresultat och emotionellt välbefinnande.



Resultaten visar att



1. Valet av statistisk definition och neuropsykologiska metoder är avgörande för hur många patienter som definieras som kognitivt försämrade efter kranskärlskirurgi.



2. Inga skillnader fanns mellan patienter efter kranskärlskirurgi eller ballongdilatation (PCI) och deras makar avseende uppskattning av patientens minne, uppmärksamhet, emotionella välbefinnande, social funktion och allmänna hälsa 1-2 år efter respektive ingrepp. Minnesfunktion var enda området som patienterna i båda grupperna bedömde som försämrat jämfört med före ingreppet.



3. Förhöjda nivåer av äggviteämnet S100B 2 dagar efter hjärtkirurgi är en oberoende prediktor för dödlighet efter 1-3 år.



4. Patienter med förhöjda nivåer av S100B 2 dagar efter en hjärtoperation hade förhöjd state och trait ångest och sämre självuppskattad fysisk funktion 3-6 år efter operationen. S100B var en oberoende prediktor av ångestnivå. Det fanns inga skillnader i neuropsykologiska testresultat mellan patienter med och utan förhöjda S100B nivåer.



Sammanfattningsvis är definitionen av kognitiv försämring och val av neuropsykologiska metoder avgörande för incidensen av diffus kognitiv dysfunktion after kranskärlskirurgi. Det fanns inga skillnader i subjektiv kognitiv funktionsförmåga 1-2 år efter kranskärlskirurgi mellan patienter som genomgått kranskärlskirurgi jämfört med matchade patienter som genomgått ballongvidgning med PCI. Patienternas skattningar av kognitiv funktion överensstämde med make/makes skattningar. I denna avhandling fanns inget stöd för att äggviteämnet S100B skulle vara en prediktor för kognitiv funktionsnivå 3-6 år efter en hjärtoperation med hjärt- lungmaskin. Däremot var S100B en stark prediktor för överlevnad och state och trait ångest flera år efter operationen. Orsakerna till de förhöjda S100B nivåerna är ännu okända. (Less)
Abstract
Despite considerable research efforts, the incidence and mechanisms of diffuse cognitive impairment after coronary artery bypass surgery are not fully understood. The aim of the dissertation was to describe cognitive changes after coronary artery bypass grafting (CABG) and the predictors and consequences thereof.



Neuropsychological tests, interviews and questionnaires were used to assess objective and subjective cognitive function after coronary artery bypass surgery. Protein S100B was also evaluated as a possible biochemical marker for cognitive function, mortality, and emotional state.



The results can be summed up in the following four points:



1. The choice of statistical... (More)
Despite considerable research efforts, the incidence and mechanisms of diffuse cognitive impairment after coronary artery bypass surgery are not fully understood. The aim of the dissertation was to describe cognitive changes after coronary artery bypass grafting (CABG) and the predictors and consequences thereof.



Neuropsychological tests, interviews and questionnaires were used to assess objective and subjective cognitive function after coronary artery bypass surgery. Protein S100B was also evaluated as a possible biochemical marker for cognitive function, mortality, and emotional state.



The results can be summed up in the following four points:



1. The choice of statistical definition and neuropsychological methods were significant predictors of the incidence of cognitive impairment after coronary artery bypass surgery.



2. There were no differences in subjective patient or spouse ratings of memory, concentration, emotional well-being, social functioning and general health 1-2 years after coronary artery bypass surgery and percutaneous transluminal coronary angioplasty. Only in memory function did patients and spouses report a postprocedural decline.



3. Elevated serum levels of protein S100B (>.3µg/L) 38-42 hours after cardiac surgery were an independent predictor of mortality 1-3 years after surgery.



4. After 3-6 years, patients with elevated S100B 38-42 hours after cardiac surgery had significantly higher state and trait anxiety compared with patients without elevated S100B levels. S100B was an independent predictor of state and trait anxiety. Patients with elevated S100B levels also rated their physical health as poorer. There were no differences in neuropsychological test performance, depression or blind interviewer ratings between the two groups.



In conclusion, statistical and neuropsychological methods are decisive factors in defining the incidence of cognitive impairment after coronary artery bypass surgery. There were no differences in subjective measures of well-being in patients undergoing coronary artery bypass surgery compared with a comparable nonsurgical control group. Both groups reported a decrease in memory function; spouse and patient ratings were in agreement. Elevated S100B two days after surgery was a significant predictor of long-term mortality and anxiety, but not of neuropsychological function. The cause of the postoperative S100B elevation is largely unknown. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Docent Währborg, Peter, Institutionen för medicin, Sahlgrenska Akademin, Göteborg
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Neurologi, neuropsychology, neurophysiology, Neurology, coronary artery bypass surgery, S100B, neuropsychological function, neuropsykologi, neurofysiologi, Psychology, Psykologi
in
The Annals of Thoracic Surgery; Scandinavian Cardiovascular Journal
pages
134 pages
publisher
Department of Psychology, Lund University
defense location
sal Nya Fest, AF-Borgen, Sandgatan 2, Lund
defense date
2007-01-18 14:00
external identifiers
  • Other:LUSADG/SAPS--07/1137-SE
ISBN
91-628-6918-3
language
English
LU publication?
yes
id
c953077f-3ffb-497d-a740-73718be62e18 (old id 547351)
date added to LUP
2007-09-10 13:52:09
date last changed
2016-09-19 08:45:04
@misc{c953077f-3ffb-497d-a740-73718be62e18,
  abstract     = {Despite considerable research efforts, the incidence and mechanisms of diffuse cognitive impairment after coronary artery bypass surgery are not fully understood. The aim of the dissertation was to describe cognitive changes after coronary artery bypass grafting (CABG) and the predictors and consequences thereof.<br/><br>
<br/><br>
Neuropsychological tests, interviews and questionnaires were used to assess objective and subjective cognitive function after coronary artery bypass surgery. Protein S100B was also evaluated as a possible biochemical marker for cognitive function, mortality, and emotional state.<br/><br>
<br/><br>
The results can be summed up in the following four points:<br/><br>
<br/><br>
1. The choice of statistical definition and neuropsychological methods were significant predictors of the incidence of cognitive impairment after coronary artery bypass surgery.<br/><br>
<br/><br>
2. There were no differences in subjective patient or spouse ratings of memory, concentration, emotional well-being, social functioning and general health 1-2 years after coronary artery bypass surgery and percutaneous transluminal coronary angioplasty. Only in memory function did patients and spouses report a postprocedural decline.<br/><br>
<br/><br>
3. Elevated serum levels of protein S100B (&gt;.3µg/L) 38-42 hours after cardiac surgery were an independent predictor of mortality 1-3 years after surgery.<br/><br>
<br/><br>
4. After 3-6 years, patients with elevated S100B 38-42 hours after cardiac surgery had significantly higher state and trait anxiety compared with patients without elevated S100B levels. S100B was an independent predictor of state and trait anxiety. Patients with elevated S100B levels also rated their physical health as poorer. There were no differences in neuropsychological test performance, depression or blind interviewer ratings between the two groups.<br/><br>
<br/><br>
In conclusion, statistical and neuropsychological methods are decisive factors in defining the incidence of cognitive impairment after coronary artery bypass surgery. There were no differences in subjective measures of well-being in patients undergoing coronary artery bypass surgery compared with a comparable nonsurgical control group. Both groups reported a decrease in memory function; spouse and patient ratings were in agreement. Elevated S100B two days after surgery was a significant predictor of long-term mortality and anxiety, but not of neuropsychological function. The cause of the postoperative S100B elevation is largely unknown.},
  author       = {Dautovic Bergh, Cecilia},
  isbn         = {91-628-6918-3},
  keyword      = {Neurologi,neuropsychology,neurophysiology,Neurology,coronary artery bypass surgery,S100B,neuropsychological function,neuropsykologi,neurofysiologi,Psychology,Psykologi},
  language     = {eng},
  pages        = {134},
  publisher    = {ARRAY(0x8c02980)},
  series       = {The Annals of Thoracic Surgery; Scandinavian Cardiovascular Journal},
  title        = {Neuropsychological Function After Coronary Artery Bypass Grafting},
  year         = {2007},
}