Cognitive outcome and therapeutic interventions for coronary artery disease.

随着人们年龄的增长，痴呆症被认为是影响生活质量的一个日益重要的因素。心脏病死亡人数正在下降，部分原因是手术技术的改进，以及使用侵入性较小的方法来保持动脉畅通，如冠状动脉支架置入术。现在众所周知，20%到60%的患者在心脏手术后会经历某种程度的思维能力障碍（认知障碍），这种情况会持续数年，并可能增加长期问题的风险。认知障碍在很多方面影响着人们。虽然目前尚不清楚认知障碍的发生是否会导致痴呆，但人们认为轻度认知障碍（MCI）可能会导致痴呆。我们建议从客观诊断前，即冠状动脉造影前，以及经过和随后的进一步治疗干预（如支架植入或心脏手术）的12个月期间，探索冠状动脉疾病患者的MCI与术后认知缺陷（PPCD）之间的联系。我们的试点数据表明，血管造影后确实会发生PPCD，我们建议确定这种情况持续多久，MCI是否易发生PPCD，以及是否最好等到病情消退后再进行进一步干预。通过这种方式，我们希望为冠状动脉疾病患者确定最安全的治疗策略，在对其症状进行调查和治疗后，将认知缺陷的发生和可能的长期认知变化降至最低。

Dementia is recognized as an increasingly important factor affecting quality of life as people age. Deaths from heart disease are declining, in part due to improved surgical techniques and to the use of less invasive methods to keep arteries open such as coronary stenting. It is now well known that 20 to 60% of patients experience some degree of impairment in thinking ability (cognitive impairment) after cardiac surgery, that this will persist in some of these individuals for years and may increase the risk of long-term problems. Cognitive impairment affects people in many ways. While it is not yet known whether the occurrence of cognitive impairment predisposes to dementia, it is thought that Mild Cognitive Impairment (MCI) may do so. We propose to explore the link between MCI and Post Procedural Cognitive Deficit (PPCD) in patients with coronary disease from before the first point of objective diagnosis, i.e. prior to the coronary angiogram, and over a 12-month period, through and subsequent to further treatment interventions such as stenting or cardiac surgery. Our Pilot data suggest that PPCD does indeed occur after angiography, and we propose to identify how long this lasts, whether MCI predisposes to it and whether it is better to wait until it resolves before further interventions are undertaken. In this way we hope to identify the safest treatment strategy for patients with coronary disease that will minimize the occurrence of Cognitive Deficit and possibly longer-term cognitive changes after investigation and treatment for their symptoms.