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Br J Anaesth. 2017 Aug 1;119(2):308-315. doi: 10.1093/bja/aex053.

Association between delirium and cognitive change after cardiac surgery.

Author information

1
Department of Anesthesiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
2
Institute of Psychology, Health, Medical, and Neuropsychology Unit, Faculty of Social Sciences, Leiden University, PO Box 9555, RB 2300 Leiden, The Netherlands.
3
Department of Intensive Care Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.

Abstract

Background:

Previous studies provide inconsistent data on whether postoperative delirium (POD) is a risk factor for postoperative cognitive decline (POCD). We thus investigated the relationship between POD and cognitive change after cardiac surgery and assessed the relationship between preoperative cognitive domain scores and POD.

Methods:

Postoperative delirium was assessed with the Confusion Assessment Method (CAM) adapted for the intensive care unit and the conventional CAM accompanied by chart review. Cognitive function was assessed with a neuropsychological test battery before elective cardiac surgery and 1 month and 1 yr afterwards. Cognitive change was calculated using the Reliable Change Index (RCI). Multiple linear regression was used to adjust for confounding.

Results:

Of the 184 patients who completed baseline assessment, 23 (12.5%) developed POD. At 1 month, the decline in cognitive performance was worse in patients with POD [median composite RCI -1.00, interquartile range (IQR) -1.67 to 0.28] than in patients without POD (RCI -0.04, IQR -0.70 to 0.63, P =0.02). At 1 yr, both groups showed cognitive improvement on average compared with baseline (POD patients median composite RCI 0.25, IQR -0.42 to 1.31, vs non-POD patients RCI 0.92, IQR 0.18-1.53; P =0.08). Correction for differences in age and level of education did not change the results. Patients with POD performed less well than patients without POD on the preoperative Trailmaking test part A ( P =0.03).

Conclusions:

Postoperative delirium is independently associated with cognitive decline 1 month after surgery, but cognitive performance generally recovers in 1 yr. Patients with a predisposition to POD can be identified before surgery by worse performance in an attention task.

Clinical trial registration:

NCT00293592.

KEYWORDS:

cardiac surgical procedures; cognition; delirium; neuropsychological tests

PMID:
28854542
DOI:
10.1093/bja/aex053
[Indexed for MEDLINE]
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