Skip to main content
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1997 Jun;62(6):644–648. doi: 10.1136/jnnp.62.6.644

Neuropsychological disorders after coronary bypass surgery.

T Walzer 1, M Herrmann 1, C W Wallesch 1
PMCID: PMC1074155  PMID: 9219757

Abstract

OBJECTIVES: A prospective assessment of neuropsychological impairment in the early postoperative stage after coronary bypass surgery. METHODS: Seventy patients undergoing elective coronary bypass surgery (CABG) were investigated preoperatively, two to three and five to nine days postoperatively with a comprehensive neuropsychological assessment including orientation, word fluency, naming, arithmetic, memory, and visuoconstructive tasks. RESULTS: Patients exhibited significant early postoperative impairment affecting all tasks but naming. Except for the orientation measurement, most patients recovered by the fifth to ninth postoperative day. Only six patients had delirium according to DSM III-R criteria on the second or third postoperative day. Cluster analysis of neuropsychological data obtained on the second to third postoperative day identified 10 patients who were cognitively compromised. As a group, these patients had required a greater number of defibrillations and exhibited lower cardiac indices postoperatively. Preoperatively, patients at risk for postoperative dysfunction were characterised by lower verbal memory, word fluency, and clock orientation scores. CONCLUSIONS: Simple preoperative neuropsychological assessment may be helpful and clinically applicable in identifying patients at risk for postoperative cognitive dysfunction and may contribute to improve postoperative management aiming at the prevention of delirium or other transient neuropsychological disorders.

Full text

PDF
644

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bleecker M. L., Bolla-Wilson K., Kawas C., Agnew J. Age-specific norms for the Mini-Mental State Exam. Neurology. 1988 Oct;38(10):1565–1568. doi: 10.1212/wnl.38.10.1565. [DOI] [PubMed] [Google Scholar]
  2. Breuer A. C., Furlan A. J., Hanson M. R., Lederman R. J., Loop F. D., Cosgrove D. M., Greenstreet R. L., Estafanous F. G. Central nervous system complications of coronary artery bypass graft surgery: prospective analysis of 421 patients. Stroke. 1983 Sep-Oct;14(5):682–687. doi: 10.1161/01.str.14.5.682. [DOI] [PubMed] [Google Scholar]
  3. Dubin W. R., Field H. L., Gastfriend D. R. Postcardiotomy delirium: a critical review. J Thorac Cardiovasc Surg. 1979 Apr;77(4):586–594. [PubMed] [Google Scholar]
  4. Folks D. G., Freeman A. M., 3rd, Sokol R. S., Govier A. V., Reves J. G., Baker D. M. Cognitive dysfunction after coronary artery bypass surgery: a case-controlled study. South Med J. 1988 Feb;81(2):202–206. doi: 10.1097/00007611-198802000-00015. [DOI] [PubMed] [Google Scholar]
  5. Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  6. Kimball C. P. Psychological responses to the experience of open heart surgery. I. Am J Psychiatry. 1969 Sep;126(3):348–359. doi: 10.1176/ajp.126.3.348. [DOI] [PubMed] [Google Scholar]
  7. Kimball C. P. The experience of open heart surgery. 3. Toward a definition and understanding of postcardiotomy delirium. Arch Gen Psychiatry. 1972 Jul;27(1):57–63. doi: 10.1001/archpsyc.1972.01750250047006. [DOI] [PubMed] [Google Scholar]
  8. Shaw P. J., Bates D., Cartlidge N. E., French J. M., Heaviside D., Julian D. G., Shaw D. A. Long-term intellectual dysfunction following coronary artery bypass graft surgery: a six month follow-up study. Q J Med. 1987 Mar;62(239):259–268. [PubMed] [Google Scholar]
  9. Smith L. W., Dimsdale J. E. Postcardiotomy delirium: conclusions after 25 years? Am J Psychiatry. 1989 Apr;146(4):452–458. doi: 10.1176/ajp.146.4.452. [DOI] [PubMed] [Google Scholar]
  10. Sotaniemi K. A. Cerebral outcome after extracorporeal circulation. Comparison between prospective and retrospective evaluations. Arch Neurol. 1983 Feb;40(2):75–77. doi: 10.1001/archneur.1983.04050020037006. [DOI] [PubMed] [Google Scholar]
  11. Sotaniemi K. A., Mononen H., Hokkanen T. E. Long-term cerebral outcome after open-heart surgery. A five-year neuropsychological follow-up study. Stroke. 1986 May-Jun;17(3):410–416. doi: 10.1161/01.str.17.3.410. [DOI] [PubMed] [Google Scholar]
  12. Treasure T., Smith P. L., Newman S., Schneidau A., Joseph P., Ell P., Harrison M. J. Impairment of cerebral function following cardiac and other major surgery. Eur J Cardiothorac Surg. 1989;3(3):216–221. doi: 10.1016/1010-7940(89)90069-9. [DOI] [PubMed] [Google Scholar]
  13. Tufo H. M., Ostfeld A. M., Shekelle R. Central nervous system dysfunction following open-heart surgery. JAMA. 1970 May 25;212(8):1333–1340. [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES