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Background:
Hospital procedures have been associated with cognitive change in older patients. This study aimed to document the prevalence of mild cognitive impairment in individuals undergoing left heart catheterization (LHC) before the procedure and the incidence of cognitive decline to 3 months afterwards.
Methods and results:
We conducted a p...
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Context 1
... testing (computerized) at the time of hospital discharge (or 24 hours) and also at 7 days after procedure showed no group-level difference compared with controls (Table 3). There was also no group-level difference between baseline and 3-month computerized testing for either LHC (Table 4); however, written test performance was more impaired in patients than controls in CERAD Auditory Verbal Learning Test delayed recall, Con- trolled Oral Word Association Test, and CERAD semantic fluency (as for baseline) and also in the Digit Symbol Substitution Test and Trail Making Test Parts A and B (Table 5). ...
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Intraprocedural stroke is a well-documented and feared potential risk of cardiovascular transcatheter procedures (TPs). Moreover, subclinical neurological events or covert central nervous system infarctions are concerns related to the development of dementia, future stroke, cognitive decline, and increased risk of mortality. Cerebral protection dev...
Citations
... Owing to the probable risks and complications of cardiac catheterization in humans (Scott et al. 2018; Al-Hijji et al. 2019), we opted for a non-invasive end-diastolic pressure (EDP) estimation from the echocardiography. In this regard, the early mitral inflow velocity to the mitral annular velocity at early diastole ratio (E/e′) was used for the estimation of the LV pressure (Ommen et al. 2000;Schwarzl et al. 2016;Zhang et 225 al. 2020). ...
Biomechanics-based patient-specific modeling is a promising approach that has proved invaluable for its clinical potential to assess the adversities caused by ischemic heart disease (IDH). In the present study, we propose a framework to find the passive material properties of the myocardium and the unloaded shape of cardiac ventricles simultaneously in patients diagnosed with ischemic cardiomyopathy (ICM). This was achieved by minimizing the difference between the simulated and target end-diastolic pressure-volume relationships (EDPVRs) using black-box Bayesian optimization, based on the finite element analysis (FEA). End-diastolic (ED) biventricular geometry and the location of the ischemia were determined from cardiac magnetic resonance (CMR) imaging. We employed our pipeline to model the cardiac ventricles of three patients aged between 57 and 66 years, with and without the inclusion of valves. An excellent agreement between the simulated and target EDPVRs has been reached. Our results revealed that the incorporation of valvular springs typically leads to lower hyperelastic parameters for both healthy and ischemic myocardium, as well as a higher fiber Green strain in the viable regions compared to models without valvular stiffness. Furthermore, the addition of valve-related effects did not result in significant changes in myofiber stress after optimization. We concluded that more accurate results could be obtained when cardiac valves were considered in modeling ventricles. The present novel and practical methodology paves the way for developing digital twins of ischemic cardiac ventricles, providing a non-invasive assessment for designing optimal personalized therapies in precision medicine.
... Owing to the probable risks and complications of cardiac catheterization in humans (Scott et al. 2018; Al-Hijji et al. 2019), we opted for a non-invasive end-diastolic pressure (EDP) estimation from the echocardiography. In this regard, the early mitral inflow velocity to the mitral annular velocity at early diastole ratio (E/e′) was used for the estimation of the LV pressure (Ommen et al. 2000;Schwarzl et al. 2016;Zhang et 225 al. 2020). ...
Biomechanics-based patient-specific modeling is a promising approach that has proved invaluable for its clinical potential to assess the adversities caused by ischemic heart disease (IHD). In the present study, we propose a framework to find the passive material properties of the myocardium and the unloaded shape of cardiac ventricles simultaneously in patients diagnosed with ischemic cardiomyopathy (ICM). This was achieved by minimizing the difference between the simulated and target end-diastolic pressure-volume relationships (EDPVRs) using black-box Bayesian optimization, based on the finite element analysis (FEA). End-diastolic (ED) biventricular geometry and the location of the ischemia were determined from cardiac magnetic resonance (CMR) imaging. We employed our pipeline to model the cardiac ventricles of three patients aged between 57 and 66 years, with and without the inclusion of valves. An excellent agreement between the simulated and target EDPVRs has been reached. Our results revealed that the incorporation of valvular springs typically leads to lower hyperelastic parameters for both healthy and ischemic myocardium, as well as a higher fiber Green strain in the viable regions compared to models without valvular stiffness. Furthermore, the addition of valve-related effects did not result in significant changes in myofiber stress after optimization. We concluded that more accurate results could be obtained when cardiac valves were considered in modeling ventricles. The present novel and practical methodology paves the way for developing digital twins of ischemic cardiac ventricles, providing a non-invasive assessment for designing optimal personalized therapies in precision medicine.
... Our findings paralleled those of a research done in geriatric patients, where the most commonly given medication classes were CCBs [15]. These findings are consistent with guidelines that advocate CCBs as a first-line treatment option for individuals with hypertension and diabetes [16]. ...
Background and Aim: During anesthesia, hypertension is the most common additional risk factor that contributes to higher mortality rate. Antihypertension medicine’s withdrawal might leads to symptoms such as anxiety, rebound hypertension, myocardial infarction, tachyarrhythmia, angina exaggeration, and sudden death. The present study aimed to assess the perioperative management of blood pressure and effects of anesthesia in hypertensive patients undergoing general and orthopedic surgery. Patients and Methods: This cross-sectional study was carried out on 162 hypertensive patients in the General Surgery and Orthopedics Units of Khyber Teaching Hospital, Peshawar for the duration from April 2022 to September 2022. Study protocol was approved by institute ethical committee. Patients aged 16 to 70 years of either gender underwent general surgery and orthopaedic surgery were enrolled. The data was acquired during the anesthetist’s initial visit to the operated hypertensive patients' 24 hour postoperative period. Antihypertensive medications, hemodynamics, anesthesia drugs, fluid use, and blood loss were main variables noted. Heart rate, systolic blood pressure, and diastolic blood pressure were Intraoperative hemodynamics. SPSS version 27 was used for data analysis. Results: Of the total 162 hypertensive patients, there were 68 (42%) male and 94 (58%) females. The overall mean age was 58.62±8.4 years. Before surgery, about 119 (73.5%) patients took antihypertensive medication whereas 124 (76.5%) had antihypertensive medication within 24 hours. The most prevalent antihypertensive medication used and most common class during postoperative management was Calcium channel Blockers and Amlodipine. The most prevalent used anesthetic drug use was Bupivacaine. The incidence of Systolic Blood Pressure (SBP) fall and rise was found in 28 and 6 patients respectively. The incidence of Diastolic Blood Pressure (DBP) fall and rise during intraoperative management was 11 and 8 patient respectively. Conclusion: The present study found that a decreased heart rate in patients who were taking beta blockers consistently. Those who took diuretics had greater DBP and HR at the completion of the procedure. There was no significant change in hemodynamic parameters with any other antihypertensive treatment. Keywords: Hypertension, General Surgery, Orthopaedic, Hemodynamics
... Moreover, older patients admitted for coronary artery bypass surgery are more likely to display a range of pre-existing lifestyle (i.e., smoking) or medical risk factors or comorbidities, such as pain or pre-existing cognitive impairment that may be exacerbated in response to surgery and influence POCD. Together, these risk factors have been conceptualised and grouped as indicators of neurocognitive frailty [47,48], representing the inability to withstand a physiologic stressor such as surgery [49]. Similarly, the proinflammatory processes initiated through the peri-operative period may play a major role in developing neurocognitive disorders amongst older cohorts [50]. ...
This umbrella review aimed to systematically identify the peri-operative risk factors associated with post-operative cognitive dysfunction (POCD) using meta-analyses of observational studies. To date, no review has synthesised nor assessed the strength of the available evidence examining risk factors for POCD. Database searches from journal inception to December 2022 consisted of systematic reviews with meta-analyses that included observational studies examining pre-, intra- and post-operative risk factors for POCD. A total of 330 papers were initially screened. Eleven meta-analyses were included in this umbrella review, which consisted of 73 risk factors in a total population of 67,622 participants. Most pertained to pre-operative risk factors (74%) that were predominantly examined using prospective designs and in cardiac-related surgeries (71%). Overall, 31 of the 73 factors (42%) were associated with a higher risk of POCD. However, there was no convincing (class I) or highly suggestive (class II) evidence for associations between risk factors and POCD, and suggestive evidence (class III) was limited to two risk factors (pre-operative age and pre-operative diabetes). Given that the overall strength of the evidence is limited, further large-scale studies that examine risk factors across various surgery types are recommended.
... Based on data for postoperative cognitive decline (POCD), the incidence of PND >6 months after CABG is likely to be 25% to 38% 1 ; 3month POCD after elective left heart catheterization occurs in 8% to 13%. 2 POCD is associated with decreased quality of life and functional capacity, earlier departure from the workforce, future Alzheimer' disease and Alzheimer' disease-related dementias, and premature mortality. 3,4 Tang et al CABG/PCI Memory Decline Prediction Model Calls for broadly discussing PND/POCD as part of informed consent preoperatively have been largely unheeded, and a better understanding of individualized risk for PND may help with preoperative risk discussions. ...
Background
Durable memory decline may occur in older adults after surgical (coronary artery bypass grafting [CABG]) or nonsurgical (percutaneous coronary intervention) coronary revascularization. However, it is unknown whether individual memory risk can be predicted. We reanalyzed an epidemiological cohort of older adults to predict memory decline at ≈1 year after revascularization.
Methods and Results
We studied Health and Retirement Study participants who underwent CABG or percutaneous coronary intervention at age ≥65 years between 1998 and 2015 and participated in ≥1 biennial postprocedure assessment. Using a memory score based on direct and proxy cognitive tests, we identified participants whose actual postprocedure memory score was 1–2 (“mild”) or >2 (“major”) SDs below expected postprocedure performance. We modeled probability of memory decline using logistic regression on preoperatively known factors and evaluated model discrimination and calibration. A total of 1390 participants (551 CABG, 839 percutaneous coronary intervention) underwent CABG/percutaneous coronary intervention at 75±6 years old; 40% were women. The cohort was 83% non‐Hispanic White, 8.4% non‐Hispanic Black, 6.4% Hispanic ethnicity, and 1.7% from other groups masked by the HRS (Health and Retirement Study) to preserve participant confidentiality. At a median of 1.1 (interquartile range, 0.6–1.6) years after procedure, 267 (19%) had mild memory decline and 88 (6.3%) had major memory decline. Factors predicting memory decline included older age, frailty, and off‐pump CABG; obesity was protective. The optimism‐corrected area under the receiver operator characteristic curve was 0.73 (95% CI, 0.71–0.77). A cutoff of 50% probability of memory decline identified 14% of the cohort as high risk, and was 94% specific and 30% sensitive for late memory decline.
Conclusions
Preoperative factors can be used to predict late memory decline after coronary revascularization in an epidemiological cohort with high specificity.
... Nová nomenklatura navržená ASA Brain Health Initiative Summit sjednotila v souladu s diagnostickým a statistickým manuálem duševních Mezi předoperační rizikové faktory vzniku PND patří NCD, demence, nižší dosažené vzdělání, anémie, historie vaskulárního onemocnění a předchozí mozková příhoda nebo infekce SARS -CoV-19 [8][9][10][11][12][13]. Věk je nezávislým rizikovým faktorem [14]. ...
... Neurological complications, mainly manifested as cognitive impairment, have gradually become a common postoperative complication [12]. Cognitive change is generally observed in patients over a period after surgery. ...
Background
Quadratus lumborum block (QLB) is a novel and effective postoperative analgesia method for abdominal surgeries. However, whether QLB can affect early postoperative cognitive function by inhibiting surgical traumatic stress and the inflammatory response remains unclear. This study aimed to explore the effect of QLB on postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy.
Methods
Sixty-four elderly patients who underwent laparoscopic radical gastrectomy were randomly divided into the QLB group (Q group, n = 32) and control group (C group, n = 32). The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to measure cognitive function 1 day before and 7 days after surgery. Postoperative cognitive dysfunction (POCD) was defined as a decline of ≥ 1 SD in both tests. The visual analog scale (VAS) scores 6 h (T1), 24 h (T2), and 48 h (T3) after surgery were measured. The serum levels of high mobility group box protein 1 (HMGB1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were evaluated 1 day before surgery (baseline), and 1 day (day 1) and 3 days after surgery (day 3). The intraoperative remifentanil dosage, sufentanil consumption 24 h after surgery, recovery time from anesthesia, and adverse effects were also compared.
Results
POCD was present in two patients in the QLB group and eight patients in the C group 7 days after surgery (6.7 % vs. 27.6 %, P = 0.032). The MMSE and MoCA scores were similar in both groups preoperatively, and the two scores were higher in the QLB group than in the C group 7 days after surgery ( P < 0.05). The VAS scores were significantly lower in the Q group at all times after surgery ( P < 0.05). Compared with the C group, the levels of HMGB1, TNF-α, and IL-6 were significantly decreased 1 and 3 days after surgery in the QLB group ( P < 0.05). The remifentanil consumption intraoperatively and sufentanil 24 h postoperatively were significantly lower in the QLB group ( P < 0.05). The recovery time from anesthesia was shorter in the QLB group ( P < 0.05). No severe adverse effects occurred in either group.
Conclusions
QLB could improve postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy. This may be related to the suppression of the inflammatory response after surgery.
Trial registration
Chictr.org.cn identifier ChiCTR1900027574 (Date of registry: 19/11/2019, prospectively registered).
... As mentioned above, "new" cognitive impairment, as distinct from POD, occurs in up to 20% of individuals aged 65 years or older up to 12 months or more following anesthesia and surgery. 3 The definition of "new" is used because patients present to hospital preoperatively as independent individuals, signing their own surgical consent, and having no previous diagnosis of cognitive impairment. However, we know from a number of studies that approximately 20-50% of these individuals have subtle cognitive impairment preoperatively which is only detected if appropriate neuropsychological tests are undertaken. ...
... However, we know from a number of studies that approximately 20-50% of these individuals have subtle cognitive impairment preoperatively which is only detected if appropriate neuropsychological tests are undertaken. 3,13 This poses an important question: Is cognitive decline that occurs in the postoperative period, including POD, submit your manuscript | www.dovepress.com ...
General anesthesia has been administered for over 150 years, and in that time, has become progressively safer. Improvements in outcomes have been driven by multiple advances, including the use of non-invasive monitors to assess cardiovascular and respiratory status. More recent advances have included the development and use of monitors to measure neurologic status by means of “processed” electroencephalography (pEEG), wherein the frontal EEG signal is analyzed by proprietary algorithms to produce a dimensionless number (scaled from 0 to 100), wherein low values are associated with deepening levels of sedation that progresses to loss of consciousness. Such monitors have been shown to enable anesthetic titration so as to expedite emergence and early recovery, and their use is advocated for the prevention of intraoperative awareness in the setting of administration of total intravenous anesthesia and neuromuscular blockade. Whether their use can minimize, or prevent, longer term adverse events is a matter of debate. In this narrative review of the most recent literature, we provide an assessment on the use of pEEG monitors in the prevention of a notable, and important, postoperative adverse outcome – delirium – in elderly patients. As we will discuss, the existing data do not support its routine use for the prevention of postoperative delirium in this, or any other, patient population.
... 7 Elective left heart catheterization may be associated with long-term cognitive decline, particularly in patients with preexisting cognitive impairment. 8 After cardiac surgery, 40% of patients who develop post-operative delirium never return to their preoperative cognitive baseline, which may result in long-term functional impairment and prolonged institutional care. 9 These are important patient-and family-centered outcomes that are not typically discussed as part of the surgical consent process, 10 especially in the urgent and emergent setting. ...
... However, several studies have evaluated the cognitive function of the patients, who underwent cardiac surgery and coronary artery bypass grafting [29][30][31][32][33][34]; but, a few observational prospective studies have demonstrated the effect of PCI procedures on cognitive function in CAD patients [3,35]. ...
... Based on the results of the previous studies, it seems that psychomotor function and attention most commonly affected domains in PCI patients, whereas the data are usually scarce about the RT and anticipatory skill after PCI [3,35,36]. ...
Introduction: Percutaneous Coronary Intervention (PCI) is a non-surgical procedure for the treatment of Coronary Artery Diseases (CADs). One of the most common disorders associated with these procedures is the occurrence of Cognitive Impairments (CIs). This study aimed to assess the Reaction Time (RT) and anticipatory skill of PCI patients and healthy subjects, using computer-based software as a safe and easy method.
Materials and Methods: Ten male PCI patients and ten healthy male individuals participated in this cross-sectional study. Auditory choice and complex choice RT, visual choice and complex choice RT, and anticipatory skill of the low and high speed of the ball of both groups were analyzed by Speed Anticipation Reaction Test (SART) software.
Results: No significant difference was seen between two groups in terms of simple auditory RT (P=0.15), auditory complex choice of RT (P=0.19), and anticipatory skills of the low speed of the ball (P=0.16). However, the performance of PCI patients was significantly worse on the simple visual RT (P=0.01), visual complex choice RT (P=0.05), and anticipatory skill of the high speed of the ball (P=0.04) compared to those of the healthy controls.
Conclusion: The assessment of RT and anticipatory skill as neurocognitive tests is considered to be one of the useful methods for evaluating the cognition function of patients, who have cardiovascular diseases. Furthermore, the pilot study suggests that PCI patients had a similar or even poorer performance in cognitive function compared with healthy people.
