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Am J Geriatr Psychiatry. 2018 Dec 25. pii: S1064-7481(18)30623-7. doi: 10.1016/j.jagp.2018.12.025. [Epub ahead of print]

Depression Predicts Delirium After Coronary Artery Bypass Graft Surgery Independent of Cognitive Impairment and Cerebrovascular Disease: An Analysis of the Neuropsychiatric Outcomes After Heart Surgery Study.

Author information

1
Department of Psychiatry (MAO, HBL), University of Rochester Medical Center, Rochester, NY. Electronic address: mark_oldham@urmc.rochester.edu.
2
Department of Psychiatry (KH), Yale School of Medicine, New Haven, CT.
3
Yale Center for Analytical Sciences (IL, YD), Yale School of Public Health, New Haven, CT.
4
Department of Neurology (QH), Icahn School of Medicine at Mount Sinai, New York.
5
Department of Radiology & Biomedical Imaging (LMS), Yale School of Medicine, New Haven, CT.
6
Department of Surgery (DDY), Stamford Health, Stamford, CT.
7
Department of Psychiatry (MAO, HBL), University of Rochester Medical Center, Rochester, NY.

Abstract

OBJECTIVE:

Although depression is a known risk factor for delirium after coronary artery bypass graft (CABG) surgery, it is unclear whether this risk is independent of delirium risk attributable to cognitive impairment or cerebrovascular disease. This study examines depression, mild cognitive impairment (MCI), and cerebrovascular disease as post-CABG delirium risk factors.

METHODS:

This prospective observational cohort study was performed in a tertiary-care academic hospital. Subjects were without dementia and undergoing CABG surgery. Preoperative cognitive assessment included Clinical Dementia Rating and neuropsychological battery; depression was assessed using Depression Interview and Structured Hamilton. Baseline intracranial stenosis was evaluated by transcranial Doppler of bilateral middle cerebral arteries (MCAs). Study psychiatrists assessed delirium on postoperative days 2-5 using the Confusion Assessment Method.

RESULTS:

Our analytic sample comprised 131 subjects (average age: 65.8 ± 9.2 years, 27% women). MCI prevalence was 24%, preoperative depression 10%, lifetime depression 35%, and MCA stenosis (≥50%) 28%. Sixteen percent developed delirium. Multivariate analysis revealed that age, MCI (odds ratio [OR]: 5.1; 95% confidence interval [CI]: 1.3-20.1), and preoperative depression (OR: 9.9; 95% CI: 1.3-77.9)-but not lifetime depression-predicted delirium. MCA stenosis and severity predicted delirium in univariate but not multivariate analysis. Right MCA stenosis severity predicted delirium severity, but left-sided stenosis severity did not.

CONCLUSION:

We established that the risk of delirium attributable to depression extends beyond the potential moderating influence of cognitive impairment and cerebrovascular disease alone. Even mild depression and cognitive impairment before CABG deserve recognition for their effect on post-CABG cognitive health.

KEYWORDS:

CABG; Delirium; cerebrovascular disease; cognitive impairment; depression

PMID:
30709616
DOI:
10.1016/j.jagp.2018.12.025

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