Newly Published
Review Article  |   April 2018
Neurocognitive Function after Cardiac Surgery: From Phenotypes to Mechanisms
Author Notes
  • From the Department of Anesthesiology (M.B., N.T., S.K.S., M.F.N., J.P.M.) and Division of Geriatric Behavioral Health, Department of Psychiatry and Behavioral Sciences (J.N.B), Duke University Medical Center, Durham, North Carolina.
  • Submitted for publication June 2, 2017. Accepted for publication February 26, 2018.
    Submitted for publication June 2, 2017. Accepted for publication February 26, 2018.×
  • This is a Brain Health Initiative submission.
    This is a Brain Health Initiative submission.×
  • Acknowledgments: The authors thank Kathy Gage, B.S. (Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina), for editorial assistance, and Faris Sbahi (Trinity College of Arts and Sciences, Duke University, Durham, North Carolina) for research assistance.
    Acknowledgments: The authors thank Kathy Gage, B.S. (Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina), for editorial assistance, and Faris Sbahi (Trinity College of Arts and Sciences, Duke University, Durham, North Carolina) for research assistance.×
  • Competing Interests: Dr. Berger acknowledges funding from Minnetronix, Inc. (St. Paul, Minnesota), for a project unrelated to the subject matter of this review, and has received material support (i.e., electroencephalogram monitors) for a postoperative recovery study in older adults from Masimo, Inc. (Irvine, California). Dr. Berger has also received legal consulting fees related to postoperative cognition in an older adult. Dr. Browndyke acknowledges funding from Claret Medical, Inc. (Santa Rosa, California). The other authors declare no competing interests.
    Competing Interests: Dr. Berger acknowledges funding from Minnetronix, Inc. (St. Paul, Minnesota), for a project unrelated to the subject matter of this review, and has received material support (i.e., electroencephalogram monitors) for a postoperative recovery study in older adults from Masimo, Inc. (Irvine, California). Dr. Berger has also received legal consulting fees related to postoperative cognition in an older adult. Dr. Browndyke acknowledges funding from Claret Medical, Inc. (Santa Rosa, California). The other authors declare no competing interests.×
  • Research Support: Supported by a Developing Research Excellence in Anesthesia Management (DREAM) Innovation Grant from Duke Anesthesiology (Durham, North Carolina), National Institutes of Health (Bethesda, Maryland) T32 grant No. GM08600, an International Anesthesia Research Society (IARS; San Francisco, California) Mentored Research Award, National Institutes of Health R03 AG050918, National Institutes of Health K76 AG057022, a Jahnigen Scholars Fellowship award, a small project grant from the American Geriatrics Society (New York, New York), and additional support from National Institutes of Health P30AG028716 (to Dr. Berger); a Duke Institute of Brain Science Incubator Award (Durham, North Carolina), a DREAM Innovation Grant from Duke Anesthesiology, and National Institutes of Health grant No. R01AG057525 (to Dr. Terrando); National Institutes of Health grant Nos. U01-HL088942, R01-AG042599, R01-HL130443, and R01-HL122836 (to Dr. Browndyke); National Institutes of Health R01 grant Nos. HL069081, HL054316, AG016762, and AG09663 (to Dr. Newman); and National Institutes of Health grant Nos. R21-HL109971, R21-HL108280, R01-HL096978, and R01-HL130443 (to Dr. Mathew).
    Research Support: Supported by a Developing Research Excellence in Anesthesia Management (DREAM) Innovation Grant from Duke Anesthesiology (Durham, North Carolina), National Institutes of Health (Bethesda, Maryland) T32 grant No. GM08600, an International Anesthesia Research Society (IARS; San Francisco, California) Mentored Research Award, National Institutes of Health R03 AG050918, National Institutes of Health K76 AG057022, a Jahnigen Scholars Fellowship award, a small project grant from the American Geriatrics Society (New York, New York), and additional support from National Institutes of Health P30AG028716 (to Dr. Berger); a Duke Institute of Brain Science Incubator Award (Durham, North Carolina), a DREAM Innovation Grant from Duke Anesthesiology, and National Institutes of Health grant No. R01AG057525 (to Dr. Terrando); National Institutes of Health grant Nos. U01-HL088942, R01-AG042599, R01-HL130443, and R01-HL122836 (to Dr. Browndyke); National Institutes of Health R01 grant Nos. HL069081, HL054316, AG016762, and AG09663 (to Dr. Newman); and National Institutes of Health grant Nos. R21-HL109971, R21-HL108280, R01-HL096978, and R01-HL130443 (to Dr. Mathew).×
  • Correspondence: Address correspondence to Dr. Berger: Duke South Orange Zone, Room 4317, Duke University Medical Center, Durham, North Carolina 27710. miles.berger@duke.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Review Article / Cardiovascular Anesthesia
Review Article   |   April 2018
Neurocognitive Function after Cardiac Surgery: From Phenotypes to Mechanisms
Anesthesiology Newly Published on April 4, 2018. doi:10.1097/ALN.0000000000002194
Anesthesiology Newly Published on April 4, 2018. doi:10.1097/ALN.0000000000002194
Abstract

For half a century, it has been known that some patients experience neurocognitive dysfunction after cardiac surgery; however, defining its incidence, course, and causes remains challenging and controversial. Various terms have been used to describe neurocognitive dysfunction at different times after cardiac surgery, ranging from “postoperative delirium” to “postoperative cognitive dysfunction or decline.” Delirium is a clinical diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Postoperative cognitive dysfunction is not included in the DSM-5 and has been heterogeneously defined, though a recent international nomenclature effort has proposed standardized definitions for it. Here, the authors discuss pathophysiologic mechanisms that may underlie these complications, review the literature on methods to prevent them, and discuss novel approaches to understand their etiology that may lead to novel treatment strategies. Future studies should measure both delirium and postoperative cognitive dysfunction to help clarify the relationship between these important postoperative complications.