Deficiencies in the detection of cognitive deficits

Numerous studies purport to show that cardiopulmonary bypass (CPB) surgery is associated with persistent postoperative cognitive decline. In J. R. Keith et al. (2002), the authors argued that reports of post-CPB cognitive declines have often been quantified using data analysis methods that were based on tenuous assumptions and overlooked problems associated with familywise Type I errors. Four peers who are recognized for their expertise in neuropsychological outcomes research evaluated the arguments developed in the J. R. Keith et al. article, critiqued the study presented in that article, and offered suggestions for how to investigate whether cognitive decline occurs reliably after CPB. In this reply article, the authors respond to the open-peer commentaries made regarding the J. R. Keith et al. study.