Newly Published
Perioperative Medicine  |   May 2018
Cognitive Decline after Delirium in Patients Undergoing Cardiac Surgery
Author Notes
  • From the Department of Anesthesiology and Critical Care Medicine (C.H.B., R.H., M.P.), Department of Surgery (Y.N., K.Z., K.M.), and Department of Psychiatry and Behavioral Sciences (V.K., K.J.N.), Johns Hopkins University School of Medicine, Baltimore, Maryland; New York University School of Medicine, New York, New York (J.P.); Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan (A.Y.); Biostatistics Consulting Center, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.T.); Department of Anesthesiology and Critical Care Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois (C.W.H.).
  • The association of delirium and cognitive change was examined in a small number of patients and presented as an abstract at the 2014 meeting of the American Society of Anesthesiologists on October 14, 2014, in New Orleans, Louisiana. The abstract was selected for the session “Best Abstracts: Clinical Science.”
    The association of delirium and cognitive change was examined in a small number of patients and presented as an abstract at the 2014 meeting of the American Society of Anesthesiologists on October 14, 2014, in New Orleans, Louisiana. The abstract was selected for the session “Best Abstracts: Clinical Science.”×
  • Submitted for publication December 8, 2017. Accepted for publication April 10, 2018.
    Submitted for publication December 8, 2017. Accepted for publication April 10, 2018.×
  • Acknowledgments: The authors thank the Johns Hopkins Clinical Research Core within the Department of Anesthesiology and Critical Care Medicine (Baltimore, Maryland) for resources for study conduct, the Johns Hopkins Center on Aging and Health (Baltimore, Maryland), and the Older Americans Independence Center (Baltimore, Maryland) for analytic support and guidance.
    Acknowledgments: The authors thank the Johns Hopkins Clinical Research Core within the Department of Anesthesiology and Critical Care Medicine (Baltimore, Maryland) for resources for study conduct, the Johns Hopkins Center on Aging and Health (Baltimore, Maryland), and the Older Americans Independence Center (Baltimore, Maryland) for analytic support and guidance.×
  • Research Support: Support was provided by the National Institutes of Health/National Heart Lung Blood Institute (grant No. R01 HL092259; to Dr. Hogue), National Institutes of Health/National Institute on Aging (grant Nos. K-76 AG057020, K23 AG051783), International Anesthesia Research Society, San Francisco, California, Johns Hopkins Clinician Scientist Award, Magic That Matters Grant, Older Americans Independence Center Research Career Development Award, Baltimore, Maryland (grant No. P30 AG021334; to Dr. Brown), and by the Johns Hopkins Institute for Clinical and Translational Research, Baltimore, Maryland (grant No. KL2TR001077; to Dr. Kalamath).
    Research Support: Support was provided by the National Institutes of Health/National Heart Lung Blood Institute (grant No. R01 HL092259; to Dr. Hogue), National Institutes of Health/National Institute on Aging (grant Nos. K-76 AG057020, K23 AG051783), International Anesthesia Research Society, San Francisco, California, Johns Hopkins Clinician Scientist Award, Magic That Matters Grant, Older Americans Independence Center Research Career Development Award, Baltimore, Maryland (grant No. P30 AG021334; to Dr. Brown), and by the Johns Hopkins Institute for Clinical and Translational Research, Baltimore, Maryland (grant No. KL2TR001077; to Dr. Kalamath).×
  • Competing Interests: Dr. Brown and Dr. Hogue consulted for and received grant support from Medtronic (Minneapolis, Minnesota) in unrelated areas, and Dr. Nomura has received funding from Medtronic in unrelated areas. Dr. Neufeld has received research funding from Hitachi Medical Corporation (Twinsburg, Ohio). The other authors declare no competing interests.
    Competing Interests: Dr. Brown and Dr. Hogue consulted for and received grant support from Medtronic (Minneapolis, Minnesota) in unrelated areas, and Dr. Nomura has received funding from Medtronic in unrelated areas. Dr. Neufeld has received research funding from Hitachi Medical Corporation (Twinsburg, Ohio). The other authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Brown: Johns Hopkins Hospital, 1800 Orleans St., Zayed 6208, Baltimore, Maryland 21210. cbrownv@jhmi.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
Perioperative Medicine / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Geriatric Anesthesia
Perioperative Medicine   |   May 2018
Cognitive Decline after Delirium in Patients Undergoing Cardiac Surgery
Anesthesiology Newly Published on May 15, 2018. doi:10.1097/ALN.0000000000002253
Anesthesiology Newly Published on May 15, 2018. doi:10.1097/ALN.0000000000002253
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.