Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery
Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery
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DOI：
10.1056/nejm200102083440601
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发表时间：
2001-02-08
影响因子：
158.5
通讯作者：
Blumenthal, JA
中科院分区：
文献类型：
--
作者：
Newman, MF;Kirchner, JL;Blumenthal, JA
背景：冠状动脉旁路移植术（CABG）后早期恢复出现认知能力下降的并发症，并且在多达四分之三的患者出院时和六个月后三分之一的患者中可能出现明显的认知能力下降。我们试图确定CABG术后5年的认知变化过程，以及围手术期认知功能下降对长期认知功能的影响。方法：261例接受CABG的患者，在术前（基线）、出院前、CABG手术后6周、6个月和5年进行神经认知测试。术后功能下降被定义为在四个认知功能领域中的任何一个测试中得分下降1个或更多。（降低1 SD表示功能下降约20%。）整体的神经认知状态用一个复合的认知指数分数来评估，这个分数代表了各个领域的分数之和。通过多变量逻辑回归和线性回归确定预测长期认知能力下降的因素。结果：在所研究的患者中，出院时认知能力下降的发生率为53%，6周时为36%，6个月时为24%，5年时为42%。我们调查了五年后认知功能下降的预测因素，发现出院时的认知功能是长期功能的重要预测因素(P
Background: Cognitive decline complicates early recovery after coronary-artery bypass grafting (CABG) and may be evident in as many as three quarters of patients at the time of discharge from the hospital and a third of patients after six months. We sought to determine the course of cognitive change during the five years after CABG and the effect of perioperative decline on long-term cognitive function.Methods: In 261 patients who underwent CABG, neurocognitive tests were performed preoperatively (at base line), before discharge, and six weeks, six months, and five years after CABG surgery. Decline in postoperative function was defined as a drop of 1 SD or more in the scores on tests of any one of four domains of cognitive function. (A reduction of 1 SD represents a decline in function of approximately 20 percent.) Overall neurocognitive status was assessed with a composite cognitive index score representing the sum of the scores for the individual domains. Factors predicting long-term cognitive decline were determined by multivariable logistic and linear regression.Results: Among the patients studied, the incidence of cognitive decline was 53 percent at discharge, 36 percent at six weeks, 24 percent at six months, and 42 percent at five years. We investigated predictors of cognitive decline at five years and found that cognitive function at discharge was a significant predictor of long-term function (P