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Published on: March 27, 2018
Depression predicts cognitive and functional decline one month after coronary artery bypass graft surgery
Mark A Oldham1, I-Hsin Lin2, Keith A Hawkins2
1University of Rochester Medical Center, Rochester, New York, USA.
Insights
Preoperative depression predicts cognitive and functional decline after coronary artery bypass graft (CABG) surgery. Roughly 14.5% of patients experienced decline one month post-CABG, highlighting the need to address depression before surgery.
Area of Science:
- Cardiology
- Neuropsychology
- Gerontology
Background:
- Previous research often studied cognitive and functional outcomes post-coronary artery bypass graft (CABG) surgery separately.
- This study investigates baseline depression and cognition as predictors of combined cognitive and functional decline.
Purpose of the Study:
- To assess the risk factors, specifically baseline depression and cognition, for decline in the Clinical Dementia Rating Sum-of-Boxes (CDR-SB) one month after CABG surgery.
- To analyze the relationship between preoperative neuropsychological performance and postoperative cognitive and functional status.
Main Methods:
- Prospective observational cohort study involving 148 patients undergoing CABG surgery.
- Cognition, function, and depression assessed via semi-structured interviews and the Hamilton Depression Rating Scale.
- Neuropsychological testing battery administered at baseline; CDR-SB used to define cognitive and functional status.
Main Results:
- One month post-CABG, 14.5% of patients showed a decline in CDR-SB.
- Univariate analysis identified older age, depression, baseline CDR-SB, and postoperative delirium as associated with decline.
- Multivariate regression confirmed older age (OR 1.1) and depression (OR 6.2) as significant predictors.
Conclusions:
- Approximately one in seven patients experience a decline in combined cognitive and functional status one month after CABG.
- Preoperative depression is a significant predictor of this decline, warranting clinical attention.
Background:
Prior research on cognitive and functional outcomes after coronary artery bypass graft (CABG) surgery has largely explored these two domains in isolation. In this study, we assess baseline depression and cognition as risk factors for decline in the Clinical Dementia Rating Sum-of-Boxes (CDR-SB) 1 month post-CABG surgery, which a combined measure of cognition and function.
Design:
The Neuropsychiatric Outcomes After Heart Surgery study is a prospective observational cohort study.
Setting:
A tertiary care, academic center.
Participants:
Of a total study sample of 148 patients undergoing CABG surgery, 124 (83.8%) completed 1-month follow-up assessment. Mean age was 66.3, 32 (25.8%) female and 112 (90.3%) White.
Measurements:
Cognition, function, and depression were assessed on semi-structured clinical interviews. Cognitive and functional status were defined using CDR-SB; mild or major depression was defined by the Hamilton Depression Rating Scale. Additionally, neuropsychological battery was performed at baseline.
Results:
CDR-SB decline occurred in 18 (14.5%) subjects. Older age, depression, baseline CDR-SB, and postoperative delirium were associated with 1-month decline on univariate analysis. Older age (OR 1.1 [1.0-1.2]) and depression (OR 6.2 [1.1-35.0]) remained significant on multivariate regression. In separate models, baseline performance on visual Wechsler memory scale (delayed), Hopkins verbal learning test (immediate and delayed), controlled oral word fluency test, and Trails B predicted CDR-SB decline.
Conclusion:
Roughly one in seven patients experienced CDR-SB decline 1 month after CABG surgery. Also, preoperative depression deserves recognition for being a predictor of CDR-SB decline one month post-CABG.
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