1. Neurocognitive test battery
Postoperative cognitive decline in the elderly following cardiac surgery
Kalliopi Megari1,2, Mary H. Kosmidis¹ & Kyriakos Anastasiadis²
1Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
2Department of Thoracic and Cardiovascular Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Greece 
Introduction
Postoperative cognitive deficits are significant complications after cardiac surgery, particularly in elderly patients. Various methods of extracorporeal circulation (ECC) during surgery affect postoperative cognitive recovery differentially, favoring the minimal ECC (MECC), with significantly lower risk of cognitive decline, over the conventional (CECC) system (Anastasiadis et al., 2011).
Aim of the study: We examined the relative benefit of the MECC, as compared with the CECC, system in a group of elderly (61-80 years old) and middle-aged (40-60 years old) patients undergoing coronary artery bypass grafting (CABG) both immediately post-operatively and at 3-month follow-up.
Hypothesis : Patients with MECC from both age groups will exhibit less postoperative cognitive dysfunction than those with CECC.
Method
Results
Participants: 60 patients
MECC n=29 (middle-aged=12, elderly=17) CECC n=31 (middle-aged=12, elderly=19)
Neurocognitive evaluation
Tested before surgery, prior to discharge
(1 week) and at 3-month follow-up with alternative forms of tests
Neurocognitive test battery
All patients
elderly patients from both ECC systems showed cognitive decline more often than middle-aged patients 3 months after surgery
p=.023
MECC patients
Test variables
Digit Span-Forwards
Functions
Short-term retention
Digit Span-Backwards
Verbal working memory
Stroop Color- Word Test
Executive functions
Symbol-Digit Modalities Test
Complex scanning, visual tracking
Judgment of Line Orientation Test
Visual-spatial perception
Fuld Object–Memory Evaluation Test, Storage
Short-term memory, learning
Fuld Object–Memory Evaluation Test, LT Retrieval
Long-term memory, retrieval
Geriatric Depression Scale
Depression
Positive & Negative Affect Schedule
Positive & negative mood
State-Trait Anxiety Inventory- Short Form
Anxiety
elderly patients showed impairment immediately after surgery more frequently than middle-aged patients, but there was no age related difference after 3 months.
p=.032
p=.062
CECC patients
both age groups demonstrated cognitive decline immediately and 3 months after surgery to the same extent.
Cognitive decline
A decrease of 1 SD in post-surgery relative
to pre-surgery performance on one or more
neuropsychological tests
p=.309
p=.319
Conclusions
Our findings suggest that the use of MECC systems, while beneficial in reducing postoperative neurocognitive decline for all ages, is more so for elderly patients at 3 month post-surgery follow-up.
This may be of particular importance since elderly patients are more susceptible to developing postoperative cognitive decline.
Cognitive stability plays a significant role in the life of elderly patients, especially after heart surgery.
Reference: Anastasiadis K, Argiriadou H, Kosmidis MΗ, Megari K, Thomaidou E, Antonitsis P, Karapanagiotidis G , Aretouli Ε & Papakonstantinou C. (2011). Neuro-cognitive outcome after coronary artery bypass surgery with minimal versus conventional extracorporeal circulation: A randomized pilot study. Heart, 97(13),
5th International Congress on Brain & Behavior and 18th Thessaloniki Conference of the South-East
European Society for Neurology and Psychiatry, 3-6 November 2011, Thessaloniki, Greece