COGNITIVE DYSFUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE
https://doi.org/10.20538/1682-0363-2014-6-48-56
Abstract
Coronary artery bypass graft surgery (CABG) is one of the most effective methods of surgical treatment of ischemic heart disease (IHD). However, even improvement of life quality is evident in patients underwent CABG, some neuropsychological, cognitive alterations may appear. Therefore, the problem of neurological complications in cardiac surgery is still of current interest. Prevalence of cognitive dysfunction after CABG varies from 12 to 79%. One third of the patients have alterations of cognitive functions for 1 year and more after the operation. In this review, we will discuss the current understandings on etiology, pathogenesis and prevalence of cognitive dysfunction in patients with IHD after CABG. The following factors determine development of long-lasting cognitive deficiency: lower educational level, advanced age, significant alterations of cognitive functions in preoperative period. At present, age, comorbid pathology (arterial hypertension, diabetes mellitus, vascular diseases, lung diseases), heart failure, alcohol and drug abuse, preoperative cognitive dysfunction are considered as major risk factors for CABG-induced neurological complications. Importance of timely diagnostics and early beginning of treatment of cognitive dysfunction will be discussed.
About the Authors
O. V. Yeremina
Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky
Russian Federation
Eremina Oksana V.
Russian Federation
Eremina Oksana V.
M. M. Petrova
Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky
Russian Federation
Petrova Marina M.
Russian Federation
Petrova Marina M.
S. V. Prokopenko
Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky
Russian Federation
Prokopenko Semen V.
Russian Federation
Prokopenko Semen V.
N. V. Isaeva
Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky
Russian Federation
Isaeva Natalia V.
Russian Federation
Isaeva Natalia V.
D. S. Kaskaeva
Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky
Russian Federation
Kaskaeva Daria S.
Russian Federation
Kaskaeva Daria S.
References
1. Akchurin R.S., Vasilyev V.P., Galyautdinov D.M., Korolev S.V., Lepilin M.G., Partigulov S.A., Shiryaev A.A. Sovremennaya hirurgiya koronarnyh arterii [Modern coronary surgery]. Kardiologicheskij vestnik – Cardiological Herald, 2010, no. 1. pp. 45–49 (in Russian).
2. Dadasheva M.N., Kasatkin D.S., Vishnyakova T.I. Kognitivnye rasstrojstva u bol'nyh arterial'noi gipertenziej: rannyaya diagnostika, vozmozhnosti optimizacii terapii [Cog-nitive disorders in patients with arterial hypertension: early detection, capabilities of therapy optimization]. Consilium medicum (Neurology, Rheumatology), 2011, vol. 13, no. 9, pp. 32–36 (in Russian).
3. Lokshina A.B., Zakharov V.V. Legkie i umerennye kognitivnye rasstrojstva pri discirkuljatornoj jencefalopatii [Light and moderate cognitive disorders with dyscirculatory encephalopathy]. Nevrologicheskii zhurnal – Journal of Neu-rology, 2006, no. 11 (1), pp. 57–64 (in Russian).
4. Trubnikova O.A., Mamontova A.S., Syrova I.D., Maleva O.V., Barbarash O.L. Gospital'naja dinamika pokazatelej nejropsihologicheskogo statusa u pacientov s saharnym diabetom 2 tipa, perenesshih koronarnoe shuntirovanie [Hos-pital dynamics of indices of neuropsychological status in pa-tients with type 2 diabetes mellitus undergoing coronary artery bypass grafting]. Kardiologija. Diabetes mellitus – Car-diology. Diabetes mellitus, 2012, no. 4, pp. 33–38 (in Russian).
5. Levin O.S., Dudarova M.A., Usoltseva N.I. Diagnostika i lechenie postinsultnyh kognitivnyh narushenii [Diagnosis and treatment of post-stroke cognitive impairment]. Consilium Medicum, 2010, vol. 12, no. 2, pp.126–133 (in Russian).
6. Adrianova M.Yu., Palyulina M.V., Kukayeva E.A., Milchakov V.I. Perekisnoe okislenie lipidov i soderzhanie srednih molekul pri operacijah na serdce s iskusstvennym krovoobrashheniem [Lipid peroxidation and content of the medium molecules during heart surgery with extracorporeal circulation]. Anesteziologija i reanimatologija – Anesthesiol-ogy and Resuscitation, 2001, no. 2, pp. 33–35 (in Russian).
7. Hammon J. W., Stump D. A., Kon N. D. Risk factors and so-lutions for the development of neurobehavioral changes after coronary artery bypass grafting. Ann. Thorac. Surg., 1997, vol. 63, pp. 1613–1617.
8. Moller J.T., Cluitmans P., Rasmussen L.S. Long-term post-operative cognitive dysfunction in the elderly: ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet, 1998, vol. 351, pp. 857–861.
9. Bokeriya L.A., Golukhova Ye.Z., Polunin A.G., Breskina N.Yu. Metody ocenki nevrologicheskih ishodov v kardiohirurgii [Methods of assessment of neurological outcomes in cardiac surgery]. Grudnaya i serdechno-sosudistaya hirurgiya – Thoracic and Cardiovascular Surgery, 2005, no. 2, pp. 8–14 (in Russian).
10. Coronary artery bypass graft surgery. Recommendations of the American Heart Association of Heart and American Col-lege of Cardiology. Krasnoyarsk, Platina Publ., 2000, 200 p. (in Russian).
11. Akchurin R.S., Shiryayev A.A., Dzemeshkevich S.L. Ocenka faktorov riska gospital'noj letal'nosti u bol'nyh s ishemicheskoj bolezn'ju serdca s vysokim operacionnym riskom [Assessment of risk factors for hospital mortality in patients with ischemic heart disease with high surgical risk]. Grudnaya i serdechno-sosudistaya hirurgiya – Thoracic and Cardiovascular Surgery, 2005, no. 2, pp. 14–20 (in Russian).
12. Bokeriya L.A., Buziashvili Yu.I., Yakhno N.N., Ambatiyello S.G., Motskeplishvili S.T., Aleksakhina Yu.A., Svetlova N.Yu. Kognitivnye narusheniya u bol'nyh ishemicheskoi bolezn'yu serdca, podvergshihsya operacii koronarnogo shuntirovaniya v usloviyah iskusstvennogo krovoobrashheniya [Cognitive impairment in patients with ischemic heart disease, undergoing surgery coronary artery bypass graft surgery under extracorporeal circulation]. Annaly hirurgii – Annals of Surgery, 2004, no. 1, pp. 23–27 (in Rus-sian).
13. Buziashvili Yu.I., Ambatiyello S.G., Aleksakhina Yu.A., Paschenkov M.V. Vliyanie iskusstvennogo krovoobrash-heniya na sostoyanie kognitivnyh funkcii u bol'nyh s ishemicheskoi bolezn'yu serdca [Influence of cardiopulmonary bypass on the state of cognitive function in patients with ischemic heart disease]. Zhurn. nevrologii i psihiatrii im. S.S. Korsakova – S.S.Korsakov Journal of Neurology and Psychiatry, 2005, no. 1, pp. 30–35 (in Russian).
14. Zakharov V.V., Kovtun A.Yu. Diagnostics of vascular cog-nitive alterations. Moscow, Publ., 2011, 16 p (in Russian).
15. Prokopenko S.V., Chernykh T.V., Mozheyko E.Yu., Koryagina T.D., Kaskaeva D.S. Ocenka kognitivnyh narushenii i effektivnost' ih korrekcii s ispol'zovaniem komp'juternyh programm v ostrom periode ishemicheskogo insul'ta [Evaluation of cognitive disorders and efficiency of their correction with the help of computer programs in acute period of ischemic stroke]. Sibirckoe medicinskoe obozrenie – Siberian Medical Review, 2012, vol.74, no. 2, pp. 59–62 (in Russian).
16. Shrader N.I., Shaibakova V.L., Likhvantsev V.V., Levi-kov D.I., Levin O.S. Nevrologicheskie oslozhnenija aortokoronarnogo shuntirovanija [Neurological complications of coronary artery bypass grafting]. Zhurn. nevrologii i psihiatrii im. S.S. Korsakova – S.S. Korsakov Journal of Neu-rology and Psychiatry, 2012, no. 3, pp. 76–81 (in Russian).
17. Bucerius J., Gummert J.F. Predictors of delirium after cardiac surgery delirium: effect of beatingheart (off-pump) surgery. J. Thorac. Cardiovasc. Surg., 2004, vol. 127, pp. 57–64.
18. Elwood P.C., Pickering J. Vascular disease and cognitive function in older men in the Caerphilly cohort. Age Ageing, 2002, vol. 31: 1, pp. 43–48.
19. Shrader N.I. Posleoperacionnaya kognitivnaya disfunkciya [Postoperative cognitive dysfunction]. Nevrologicheskij zhurnal – Journal of Neurology, 2005, no. 10, pp. 37–43 (in Russian).
20. Shumakov D.V., Redkoborodaya A.A., Nadzhar M.Kh. Diagnosticheskoe znachenie S-reaktivnogo belka pri operacijah v uslovijah iskusstvennogo krovoobrashhenija [Di-agnostic value of C-reactive protein during operations in conditions of artificial blood circulation]. Vestnik aritmologii – Journal of Arrhythmology, 2006, no. 529, Suppl., p. 169 (in Russian).
21. Putilina M.V. Cognitive dysfunction in cerebrovascular pa-thology. Manual for physicians. Moscow, MIA-PRINT Publ., 2011. 139 p (in Russian).
22. Eryomina O.V., Petrova M.M., Shnaider N.A. Aktual'nost' problemy kognitivnoi disfunkcii u bol'nyh arterial'noj gipertoniei [The urgency of cognitive dysfunction problem in patients with arterial hypertension]. Sibirskoe medicinskoe obozrenie – Siberian Medical Review, 2006, vol. 41, no. 4, pp. 3–10 (in Russian).
23. Petrova M.M., Shnaider N.A., Eryomina O.V. Harakteristika kognitivnyh narushenij u bol'nyh arterial'noj gipertoniei [Characteristics of cognitive impairment in patients with ar-terial hypertension]. Kardiovaskuljarnaja terapija i profilaktika – Cardiovascular Therapy and Prevention, 2008, vol. 7, no. 2, pp. 36–39 (in Russian).
24. Shnaider N.A., Petrova M.M. Profilaktika i lechenie kognitivnyh narushenii u bol'nyh arterial'noj gipertoniei [The prevention and treatment of cognitive impairment in patients with arterial hypertension]. NeuroNEWS, 2007, no. 4, pp. 63–67 (in Russian).
25. Levin O.S. Kognitivnye narusheniya v praktike terapevta: zabolevanija serdechno-sosudistoi sistemy [Cognitive im-pairment in the practice of the therapist: cardiovascular sys-tem's diseases]. Consilium medicum, 2009, vol. 11, no. 2, pp. 55–61 (in Russian).
26. Zakharov V.V., Savushkina I.Yu. Diagnostika i lechenie kognitivnyh narushenii pri discirkuljatornoii encefalopatii [Diagnosis and treatment of cognitive impairment with dyscirculatory encephalopathy]. Rus. med. zhurn – Russian Medical Journal, 2011, vol. 19, no. 2, pp. 108–112 (in Rus-sian).
27. Kilander L, Niman N, Boberg M. Vzaimosvjaz' arterial'noj gipertenzii s kognitivnymi narusheniyami: rezul'taty 20-letnego nablyudeniya 999 pacientov [The relationship of hy-pertension with cognitive impairment: results of a 20-years observation of 999 patients]. Obzory klinicheskoj kardiologii, 2005, no. 2, pp. 37–49 (in Russian).
28. Smakotina S.A., Trubnikova O.A., Anan'ko Yu.V., Zykov M.V., Plekhanova L.P., Barabarash O.L. Kognitivnye funkcii i sostojanie nejrodinamiki u pacientov s arterial'noj gipertoniej molodogo i zrelogo vozrasta [Cognitive function and neurodynamics status in young and Mature patients with arterial hypertension]. Arterial'naja gipertenzija – Arterial Hypertension. 2007, vol. 13, no. 2, pp. 145–148 (in Russian).
29. Damulin I.V. Kognitivnye narusheniya sosudistogo geneza: klinicheskie i terapevticheskie aspekty [Cognitive impairment of vascular origin: clinical and therapeutic aspects]. Trudnyj pacient, 2006., no. 7, pp. 34–36 (in Russian).
30. Damulin I.V. Kognitivnye narusheniya pri sosudistyh zabolevaniyah golovnogo mozga: nekotorye aspekty diagnostiki i terapii [Cognitive impairment in vascular diseases of the brain: some aspects of diagnosis and therapy]. Farmateka: medicinskij zhurnal, 2011, no. 19, pp. 20–28 (in Russian).
31. Bonser R.S., Pagano D. Brain Protection in Cardiac Surgery. London, Springer-Verlag, 2011. 246 p.
32. Borger M.A., Feindel C.M. Cerebral emboli during cardio-pulmonary bypass: effect of perfusionist interventions and aortic cannulas. J. Extra Corpor. Technol., 2002, vol. 34, pp. 29–33.
33. Trubnikova O.A., Tarasova I.V., Artamonova A.I., Syrova I.D., Barbarash O.L. Vozrast kak faktor riska kognitivnyh narushenij u pacientov, perenesshih koronarnoe shuntirovanie [Age as a risk factor for cognitive impairment after coronary artery by-pass surgery]. Zhurn. nevrologii i psihiatrii im. S.S. Korsakova – S.S. Korsakoff's Journal of Neurology and Psychiatry, 2011, no. 8, pp. 46–49 (in Rus-sian).
34. Jacobs A., Neveling M., Horst M. Alterations of neuropsy-chological function and cerebral glucose metabolism after cardiac surgery are not related only to intraoperative microembolic events. Stroke, 1998, vol. 29, pp. 660–667.
35. Stygall J., Newman S.P., Fitzgerald G. Cognitive change 5 years after coronary artery bypass surgery. Health Psychol., 2003, vol. 22, pp. 579–586.
36. Keith J.R., Puente A.E. Assessing postoperative cognitive change after cardiopulmonary bypass surgery. Neuropsy-chology, 2002, vol. 16: 3, pp. 411–421.
37. Lee J.D., Lee S.J., Tsushima W.T. Benefits of off-pump by-pass on neurologic and clinical morbidity: a prospective randomized trial. Ann. Thorac. Surg., 2003, vol. 76, pp. 18–26.
38. Fearn S. J., Pole R., Wesnes K. Cerebral injury during cardi-opulmonary bypass: emboli impair memory. J. Thorac. Cardiovasc. Surg., 2001, vol. 121, pp. 1150–1160.
39. Johnson R.G. Abnormal neuropsychometrics early after cor-onary artery bypass grafting. Crit. Care Med., 2000, vol. 28: 6, pp. 2142–2143.
40. Mullges W., Berg D. Early natural course of transient en-cephalopathy after coronary artery bypass grafting. Crit Care Med., 2000, vol. 28: 6, pp. 1808–1811.
41. Harmon D., Ghori K., Eustace N. Aprotinin decreases the in-cidence of cognitive deficit following CABG and cardio-pulmonary bypass: A pilot randomized controlled study. Can. J. Anesth., 2004, vol. 51, № 10, pp. 1002–1009.
42. Braekken S.K., Reinvang I., Russell D. Association between intraoperative cerebral microembolic signals and postoperative neuropsychological deficit: comparison between patients with cardiac valve replacement and patients with coronary artery bypass grafting. J. Neurol. Neurosurg. Psych., 1998, vol. 65, pp. 573–576.
43. Monk T.G., Weldon B.C., Garvan C.W. Predictors of cogni-tive dysfunction after major noncardiac surgery. Anesthesi-ology, 2008, vol. 108: 1, pp. 18–30.
44. Selnes O.A., Goldsborough M.A., Borowicz L.M. Determi-nants of cognitive change after coronary artery bypass surgery: a multifactorial problem. Ann. Thorac. Surg., 1999, vol. 67, pp. 1669–1676.
45. Clark R.E., Brillman J., Davis D.A. Microemboli during coronary artery bypass grafting. Genesis and effect on out-come. J. Thorac. Cardiovasc. Surg., 1995, vol. 109, pp. 249–257.
46. Taggart D.P., Browne S.M., Wade D.T. Neuroprotection during cardiac surgery: a randomised trial of a platelet activating factor antagonist. Heart, 2003, vol. 89, pp. 897–900.
47. Royse A.G., Royse C.F., Ajani A.E. Reduced neuropsycho-logical dysfunction using epiaortic echocardiography and the exclusive Y graft. Ann. Thorac. Surg., 2000, vol. 69, pp. 1431–1438.
48. Sparkman N.L. Neuroinflammation associated with aging sensitizes the brain to the effects of infection or stress. Neuroimmunomodulation, 2008, vol. 15, pp. 323–330.
49. Bokeriia L.A., Golukhova E.Z., Breskina N.Y. Asymmetric cerebral embolic load and postoperative cognitive dysfunction in cardiac surgery. Cerebrovasc. Dis., 2007, vol. 23, pp. 50–56.
50. Potter G.G., Plassman B.L. Age effects of coronary artery bypass graft on cognitive status change among elderly male twins. Neurology, 2004, vol. 63: 12, pp. 2245–2249.
51. Selnes O.A., Grega M.A. Cognitive changes with coronary artery disease: a prospective study of coronary artery bypass graft patients and nonsurgical controls. Ann. Thorac. Surg., 2003, vol. 75: 5, pp. 1377–1384.
52. Asahi M., Huang Z. Protective effects of statins involving both eNOS and tPA in focal cerebral ischemia. J. Cereb. Blood Flow. Metab., 2005, vol. 25, pp. 722–729.
53. Rasmussen L.S., Johnson T. Does anaesthesia cause postop-erative cognitive dysfunction? A randomized study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand., 2003, vol. 47: 3, pp. 260–266.
54. Borger M.A., Peniston C.M., Weisel R.D. Neuropsychologic impairment after coronary bypass surgery: effect of gaseous microemboli during perfusionist interventions. J. Thorac. Cardiovasc. Surg., 2001, vol. 121, pp. 743–749.
55. Diegeler A., Hirsch R., Schneider F. Neuromonitoring and neurocognitive outcome in offpump versus conventional coronary bypass operation. Ann. Thorac. Surg., 2000, vol. 69, pp. 1162–1166.
56. Zakharov V.V., Yakhno N.N. Alterations of memory. Moscow, GEOTAR Publ., 2003. 162 p. (in Russian).
57. Shnayder N.A., Nicoulina S.Yu. Cerebral complications of arterial hypertension. Rostov-on-Don, Phoenix Publ., 2007. 356 p. (in Russian).
58. Chernykh T.V., Prokopenko S.V., Mozheiko Ye.Yu. Effektivnost' korrekcii kognitivnyh rasstrojstv s ispol'zovaniem komp'juternyh stimulirujushhih programm u pacientov v ostrom periode ishemicheskogo insul'ta v zavisimosti ot lokalizacii ochaga porazhenija [The efficiency of cognitive disorders correction with the use of computer-based incentive programs for patients in acute period of ischemic stroke depending on the localization of the lesion]. Vestn. novyh med. tehnologii, 2012, vol. 19, no. 4, pp. 98–101 (in Russian).
59. Bokeriya L.A., Kamchatnov P.R., Klyuchnikov I.V., Alaver-dyan A.G., Gusev Ye.I. Cerebrovaskuljarnye rasstrojstva u bol'nyh s koronarnym shuntirovaniem [Cerebrovascular dis-orders in patients with coronary bypass surgery]. Zhurn. nevrologii i psihiatrii im. S.S. Korsakova – S.S. Korsakoff's Journal of Neurology and Psychiatry, 2008, no. 3, pp. 90–94 (in Russian).
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For citations:
Yeremina O.V., Petrova M.M., Prokopenko S.V., Isaeva N.V., Kaskaeva D.S. COGNITIVE DYSFUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE. Bulletin of Siberian Medicine. 2014;13(6):48-56. (In Russ.) https://doi.org/10.20538/1682-0363-2014-6-48-56
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