Cognitive predictors of early postoperative cognitive dysfunction in elderly cardiac surgery patients

Cognitive predictors of early postoperative cognitive dysfunction in elderly cardiac surgery patients

 

Authors

 

K.P. Dick

Federal State Budgetary Educational Institution of Higher Education “Ural State Medical University” of the Ministry of Health of the Russian Federation, Yekaterinburg, Russian Federation

A.A. Melnik

Federal State Budgetary Educational Institution of Higher Education “Ural State Medical University” of the Ministry of Health of the Russian Federation, Yekaterinburg, Russian Federation

I.A. Ponomarev

Federal State Budgetary Educational Institution of Higher Education “Ural State Medical University” of the Ministry of Health of the Russian Federation, Yekaterinburg, Russian Federation

A.T. Dovlatova

Federal State Budgetary Educational Institution of Higher Education “Ural State Medical University” of the Ministry of Health of the Russian Federation, Yekaterinburg, Russian Federation

A.D. Mamonova

State Autonomous Healthcare Institution of the Sverdlovsk Region “Sverdlovsk Regional Clinical Hospital no. 1”, Yekaterinburg, Russian Federation

A.L. Levit

Federal State Budgetary Educational Institution of Higher Education “Ural State Medical University” of the Ministry of Health of the Russian Federation, Yekaterinburg, Russian Federation; State Autonomous Healthcare Institution of the Sverdlovsk Region “Sverdlovsk Regional Clinical Hospital no. 1”, Yekaterinburg, Russian Federation

A.P. Sidenkova

Federal State Budgetary Educational Institution of Higher Education “Ural State Medical University” of the Ministry of Health of the Russian Federation, Yekaterinburg, Russian Federation

 

https://doi.org/10.26617/1810-3111-2024-3(124)-53-63

 

Journal: Siberian Herald of Psychiatry and Addiction Psychiatry. 2024; 3 (124):  53-63.

 

Abstract

Introduction. Population aging causes an increase in age-related diseases and complications after surgical treatment. Postoperative cognitive dysfunction (POCD) is a common postoperative complication characterized by a high mortality risk, decreased functional capabilities of patients, and deterioration in their quality of life. Objective: to assess the preoperative state of cognitive functions in elderly cardiac surgery patients with POCD. Materials. A prospective observational study of patients was conducted at the Cardiac Surgery Department of the Sverdlovsk Regional Clinical Hospital, Yekaterinburg. After signing a voluntary informed consent to participate, 157 patients of mean age 63.47±7.65 years were included in the study sample, including 108 (68.8%) men and 49 (31.2%) women. The somatic condition of those patients was represented by compensated cardiovascular and comorbid diseases (gastrointestinal tract, endocrine system). Methods: clinical-psychopathological, neuropsychological, psychometric, statistical. Statistical data were calculated using the Statistica 7 for Windows statistical program. Statistical analysis of the results was performed using non-parametric criteria ‒ Spearman, Fisher, χ2, descriptive statistics. Results. Two groups of patients were formed: the main group (n=39) ‒ with POCD, the comparison group (n=118) ‒ without POCD. At the preoperative stage, hippocampal, mixed, dysregulatory types of MCI and clinical signs of vascular subcortical dementia or Alzheimer's type dementia were detected. At the preoperative stage, the criteria of MCI (56.4%), moderate (12.8%) or mild (30.8%) dementia were documented in the main group, while in the comparison group, signs of cognitive disorders were frequently absent (49.7% versus 24.8%). The comparison of cognitive indices in patients of the main and comparison groups at the preoperative stage revealed statistically significant differences in the MMSE, MoCa, and FAB scales. Postoperative assessment of cognitive functions (attention concentration, executive function, working memory, delayed recall, dynamic praxis, and regulatory functions) showed a decrease in the quality of cognitive test performance in the main group. Conclusion. Examination of elderly patients before planned cardiac surgery allowed us to determine the incidence of POCD at an early postoperative stage ‒ 24.8%. Using clinical-psychopathological and neuropsychological methods, it was established that low indices of orientation, concentration of attention, operational memory, delayed reproduction, executive functions, dynamic praxis, voluntary control at the preoperative stage were typical for patients with POCD. The structure of POCD comprised dysregulatory, neurodynamic and dysmnestic disorders.

 

Keywords: old age, postoperative cognitive dysfunction, cardiac surgery, complications.

 

Article (pdf)

 

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Materials  

For citation: DickK.P., Melnik A.A., Ponomarev I.A., Dovlatova A.T., Mamonova A.D., Levit A.L., Sidenkova A.P.Cognitive predictors of early postoperative cognitive dysfunction in elderly cardiac surgery patients. Siberian Herald of Psychiatry and Addiction Psychiatry.2024; 3 (124): 53-63. https://doi.org/10.26617/1810-3111-2024-3(124)-53-63

 

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