Neurocognitive dysfunction among patients undergoing coronary artery bypass surgery-A prospective study

Neurocognitive dysfunction (NCD) remains a common complication after coronary artery bypass grafting (CABG); however, the trajectory of cognitive recovery and associated risk factors remain incompletely understood. This study evaluated the prevalence, early postoperative course, and predictors of NCD among patients undergoing elective CABG.

In this prospective observational study, 110 consecutive patients undergoing elective CABG between January 2025 and August 2025 at a tertiary care center were enrolled. Neurocognitive function was assessed using Addenbrooke's Cognitive Examination-III preoperatively, at hospital discharge, and at postoperative day 10 follow-up. Changes in cognitive performance were analyzed using repeated-measures analysis of variance with Bonferroni-adjusted pairwise comparisons. Transitions in categorical cognitive status were evaluated using the McNemar-Bowker test. Associations between patient characteristics and NCD were examined using multivariable analyses.

A total of 110 patients undergoing CABG were included in the study, with a mean age of 57.5 ± 8.5 years; 79.1% were male, and 85.5% underwent off-pump CABG. Mean Addenbrooke's Cognitive Examination-III scores declined significantly from baseline (77.0 ± 9.1) to discharge (73.8 ± 9.9), followed by recovery at follow-up (77.1 ± 10.0) (P < .001). Bonferroni-adjusted comparisons demonstrated a significant decline from baseline to discharge (mean difference -3.2; 95% CI, -4.8 to -1.6; P = .001) and a significant improvement from discharge to follow-up (mean difference +3.3; 95% CI, 1.7-4.9; P = .001), whereas baseline and follow-up scores did not differ significantly (mean difference +0.1; 95% CI, -1.5 to 1.7; P = .865). NCD was present in 68.2% of patients preoperatively, increased to 80.0% at discharge, and decreased to 64.5% at follow-up. Multivariable logistic regression analysis identified increasing age as independently associated with NCD at follow-up (adjusted odds ratio, 1.08; 95% CI, 1.02-1.14; P = .007).

In this group of patients undergoing CABG, cognitive impairment was often seen before surgery. There was a temporary decline right after the operation, followed by partial recovery by the early follow-up. The link between older age and early postoperative cognitive issues indicates that older patients may benefit from cognitive screening around the time of surgery. More research is needed to look at long-term cognitive changes and the effectiveness of specific interventions.