Cognitive Decline after Delirium in Patients Undergoing Cardiac Surgery

Charles H. Brown, Julia Probert, Ryan Healy, Michelle Parish, Yohei Nomura, Atsushi Yamaguchi, Jing Tian, Kenton Zehr, Kaushik Mandal, Vidyulata Kamath, Karin J. Neufeld, Charles W. Hogue

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Delirium is common after cardiac surgery and has been associated with morbidity, mortality, and cognitive decline. However, there are conflicting reports on the magnitude, trajectory, and domains of cognitive change that might be affected. The authors hypothesized that patients with delirium would experience greater cognitive decline at 1 month and 1 yr after cardiac surgery compared to those without delirium. Methods: Patients who underwent coronary artery bypass and/or valve surgery with cardiopulmonary bypass were eligible for this cohort study. Delirium was assessed with the Confusion Assessment Method. A neuropsychologic battery was administered before surgery, at 1 month, and at 1 yr later. Linear regression was used to examine the association between delirium and change in composite cognitive Z score from baseline to 1 month (primary outcome). Secondary outcomes were domain-specific changes at 1 month and composite and domain-specific changes at 1 yr. Results: The incidence of delirium in 142 patients was 53.5%. Patients with delirium had greater decline in composite cognitive Z score at 1 month (greater decline by −0.29; 95% CI, −0.54 to −0.05; P = 0.020) and in the domains of visuoconstruction and processing speed. From baseline to 1 yr, there was no difference between delirious and nondelirious patients with respect to change in composite cognitive Z score, although greater decline in processing speed persisted among the delirious patients. Conclusions: Patients who developed delirium had greater decline in a composite measure of cognition and in visuoconstruction and processing speed domains at 1 month. The differences in cognitive change by delirium were not significant at 1 yr, with the exception of processing speed.

Original languageEnglish (US)
Pages (from-to)406-416
Number of pages11
JournalAnesthesiology
Volume129
Issue number3
DOIs
StatePublished - 2018

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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