Heart procedures linked to cognitive decline

In a new study of German heart patients, people who had bypass surgery and those who underwent less-invasive stent procedures showed declines in thinking and memory skills a few months after the procedures.

Doctors have long been concerned about cognitive decline in patients who undergo coronary artery bypass grafting (CABG), and indeed, memory deficits were more significant after those procedures than after stenting.

Patients treated with CABG often have more severe coronary atherosclerosis. It could be that cognitive decline after these procedures more relates to the severity of the atherosclerosis than the procedure itself, said Dr Mark Newman, who studies cognitive decline after cardiac surgery at the Duke University Medical Centre in Durham, North Carolina.

Dislodged plaque

Even so, it makes sense plaque dislodged during a procedure could embolise to the brain.

The current study involved 37 patients undergoing stent procedures and 47 undergoing CABG. Most were in their 60s and early 70s. Before and three months afterward, participants completed a series of thinking and memory tests.

The changes in their test scores were compared to those from another 33 healthy volunteers.

Patients in the stent group had a greater drop in score on two out of the 10 tests, compared to controls, a few months after their procedures. Bypass patients' scores declined on seven of the tests.

Dr Tibo Gerriets from Justus Liebig University in Giessen and colleagues say in their paper, published in the October issue of the American Heart Journal, that it hasn't been clear how much the cognitive change after heart procedures really bothers people in their everyday lives.

Needing extra help

But Dr Newman, who wasn't involved in the new work, told Reuters Health that for some patients, the changes in thinking and memory skills might be the difference between leading an independent life and needing extra help.

Dr Todd Rosengart, head of cardiothoracic surgery at Stony Brook University Medical Centre in New York, said the risks of cognitive decline after bypass surgery depend on how the procedure is done – and that patients in the study might not have been managed with the best techniques.

"Nowadays doing a procedure very well means not just getting the patient through the procedure with no mortality, it means getting them through the procedure in great shape," he told Reuters Health.

(Reuters Health, November 2011) 

Read more:

Atherosclerosis

Heart surgery

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