Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-19T21:35:47.363Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictors of cognitive function in candidates for coronary artery bypass graft surgery

Published online by Cambridge University Press:  02 February 2007

CHRISTINE S. ERNEST ,
PETER C. ELLIOTT ,
BARBARA M. MURPHY ,
MICHAEL R. LE GRANDE ,
ALAN J. GOBLE ,
ROSEMARY O. HIGGINS ,
MARIAN U.C. WORCESTER  and
JAMES TATOULIS
CHRISTINE S. ERNEST
Affiliation:
Heart Research Centre, Melbourne, Victoria, Australia
PETER C. ELLIOTT
Affiliation:
Heart Research Centre, Melbourne, Victoria, Australia Australian Centre for Posttraumatic Mental Health, The University of Melbourne, Victoria, Australia
BARBARA M. MURPHY
Affiliation:
Heart Research Centre, Melbourne, Victoria, Australia Department of Psychiatry, The University of Melbourne, Victoria, Australia
MICHAEL R. LE GRANDE
Affiliation:
Heart Research Centre, Melbourne, Victoria, Australia
ALAN J. GOBLE
Affiliation:
Heart Research Centre, Melbourne, Victoria, Australia
ROSEMARY O. HIGGINS
Affiliation:
Heart Research Centre, Melbourne, Victoria, Australia
MARIAN U.C. WORCESTER
Affiliation:
Heart Research Centre, Melbourne, Victoria, Australia Department of Psychology, The University of Melbourne, Victoria, Australia
JAMES TATOULIS
Affiliation:
Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Victoria, Australia
Get access Rights & Permissions [Opens in a new window]

Abstract

Candidates for coronary artery bypass graft surgery have been found to exhibit reduced cognitive function prior to surgery. However, little is known regarding the factors that are associated with pre-bypass cognitive function. A battery of neuropsychological tests was administered to a group of patients listed for bypass surgery (n = 109). Medical, sociodemographic and emotional predictors of cognitive function were investigated using structural equation modeling. Medical factors, namely history of hypertension and low ejection fraction, significantly predicted reduced cognitive function, as did several sociodemographic characteristics, namely older age, less education, non-English speaking background, manual occupation, and male gender. One emotional variable, confusion and bewilderment, was also a significant predictor whereas anxiety and depression were not. When significant predictors from the three sets of variables were included in a combined model, three of the five sociodemographic characteristics, namely age, non-English speaking background and occupation, and the two medical factors remained significant. Apart from sociodemographic characteristics, medical factors such as a history of hypertension and low ejection fraction significantly predicted reduced cognitive function in bypass candidates prior to surgery. (JINS, 2007, 13, 257–266.)

Keywords

Cardiac patientsCoronary heart diseasePre-operative cognitionCognitive impairmentRisk factorsCognitive manifestation
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 13 , Issue 2 , March 2007 , pp. 257 - 266
Copyright
© 2007 The International Neuropsychological Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Andrew, M.J., Baker, R.A., Kneebone, A.C., & Knight, J.L. (2000). Mood state as a predictor of neuropsychological deficits following cardiac surgery. Journal of Psychosomatic Research, 48, 537–546.Google Scholar
Arbuckle, J.L. (2003). AMOS 5. Chicago, IL: SmallWaters Corp.
Bambauer, K.Z., Locke, S.E., Aupont, O., Mullan, M.G., & McLaughlin, T.J. (2005). Using the Hospital Anxiety and Depression Scale to screen for depression in cardiac patients. General Hospital Psychiatry, 27, 275–284.Google Scholar
Biringer, E., Mykletun, A., Dahl, A.A., Smith, A.D., Engedal, K., Nygaard, H.A., & Lund, A. (2005). The association between depression, anxiety, and cognitive function in the elderly general population—the Hordaland Health Study. International Journal of Geriatric Psychiatry, 20, 989–997.Google Scholar
Blumenthal, J.A., Mahanna, E.P., Madden, D.J., White, W.D., Croughwell, N.D., & Newman, M.F. (1995). Methodological issues in the assessment of neuropsychologic function after cardiac surgery. The Annals of Thoracic Surgery, 59, 1345–1350.Google Scholar
Byrne, D.G. (1994). Neuropsychological dysfunction and assessment of patients following cardiac arrest, myocardial infarction and major cardiac surgery. In S. Touyz, D. Byrne, & A. Gilandas (Eds.), Neuropsychology in Clinical Practice (pp. 286–304). Sydney: Academic Press/Harcourt Brace.
Carstairs, J.R., Myors, B., Shores, E.A., & Fogarty, G. (2006). Influence of language background on test of cognitive abilities: Australian data. Australian Psychologist, 41, 48–54.Google Scholar
Crawford, J.R. (1992). Current and premorbid intelligence measures in neuropsychological assessment. In J.R. Crawford, D.M. Parker, & W.W. McKinlay (Eds.), A Handbook of Neuropsychological Assessment (pp. 21–49). Hove, UK: Erlbaum.
Doering, L.V., Dracup, K., Caldwell, M.A., Moser, D.K., Erickson, V.S., Fonarow, G., & Hamilton, M. (2004). Is coping style linked to emotional states in heart failure patients? Journal of Cardiac Failure, 10, 344–349.Google Scholar
Elias, M.F., Elias, P.K., Robbins, M.A., Wolf, P.A., & D'Agostino, R.B. (2001). Cardiovascular risk factors and cognitive functioning: An epidemiological perspective. In S.R. Waldstein & M.F. Elias (Eds.), Neuropsychology of Cardiovascular Disease (pp. 83–104). Mahwah, NJ: Lawrence Erlbaum Associates.
Ernest, C.S., Murphy, B.M., Worcester, M.U.C., Higgins, R.O., Elliott, P.C., Goble, A.J., Le Grande, M.R., Genardini, N., & Tatoulis, J. (2006). Cognitive function in candidates for coronary artery bypass graft surgery. The Annals of Thoracic Surgery, 82, 8812–8818.Google Scholar
Ernest, C.S., Worcester, M.U.C., Tatoulis, J., Elliott, P.C., Murphy, B.M., Higgins, R.O., Le Grande, M.R., & Goble, A.J. (2006). Neurocognitive outcomes in off-pump versus on-pump bypass surgery: A randomized controlled trial. The Annals of Thoracic Surgery, 81, 2105–2114.Google Scholar
Ferraro, F.R. (Ed.). (2002). Minority and Cross-Cultural Aspects of Neuropsychological Assessment. Lisse, Netherlands: Svets & Zeitlinger.
Fitzsimons, D., Parahoo, K., & Stringer, M. (2000). Waiting for coronary artery bypass surgery: A qualitative analysis. Journal of Advanced Nursing, 32, 1243–1252.Google Scholar
Guenole, N., Englert, P., & Taylor, P.J. (2003). Ethnic group differences in cognitive ability test scores within a New Zealand applicant sample. New Zealand Journal of Psychology, 32, 49–54.Google Scholar
Hair, J.F., Black, W.C., Babin, B.J., Anderson, R.E., & Tatham, R.L. (2006). Multivariate Data Analysis (6th ed.). Upper Saddle River, NJ: Pearson Education.
Ho, P.M., Arciniegas, D.B., Grigsby, J., McCarthy, M., Jr., McDonald, G.O., Moritz, T.E., Shroyer, A.L., Sethi, G.K., Henderson, W.G., London, M.J., VillaNueva, C.B., Grover, F.L., & Hammermeister, K.E. (2004). Predictors of cognitive decline following coronary artery bypass graft surgery. The Annals of Thoracic Surgery, 77, 597–603.Google Scholar
Jonas, D.L., Blumenthal, J.A., Madden, D.J., & Serra, M. (2001). Cognitive consequences of antihypertensive. In S.R. Waldstein & M.F. Elias (Eds.), Neuropsychology of Cardiovascular Disease (pp. 167–188). Mahwah, NJ: Lawrence Erlbaum Associates.
Jonsdottir, H. & Baldursdottir, L. (1998). The experience of people awaiting coronary artery bypass graft surgery: The Icelandic experience. Journal of Advanced Nursing, 27, 68–74.Google Scholar
Kaplan, G.A., Turrell, G., Lynch, J.W., Everson, S.A., Helkala, E.L., & Salonen, J.T. (2001). Childhood socioeconomic position and cognitive function in adulthood. International Journal of Epidemiology, 30, 256–263.Google Scholar
Keith, J.R., Puente, A.E., Malcolmson, K.L., Tartt, S., Coleman, A.E., & Marks, H.F., Jr. (2002). Assessing postoperative cognitive change after cardiopulmonary bypass surgery. Neuropsychology, 16, 411–421.Google Scholar
Lezak, M.D., Howieson, D.B., & Loring, D.W. (2004). Neuropsychological Assessment (4th ed.). New York: Oxford University Press.
McNair, D.M., Lorr, M., & Droppleman, L.F. (1992). EdiTS Manual for the Profile of Mood States. San Diego, CA: Educational and Industrial Testing Service.
Millar, K., Asbury, A.J., & Murray, G.D. (2001). Pre-existing cognitive impairment as a factor influencing outcome after cardiac surgery. British Journal of Anaesthesia, 86, 63–67.Google Scholar
Mitrushina, M.N., Boone, K.B., & D'Elia, L.F. (1999). Handbook of Normative Data for Neuropsychological Assessment. New York: Oxford University Press.
Moser, D.J., Cohen, R.A., Clark, M.M., Aloia, M.S., Tate, B.A., Stefanik, S., Forman, D.E., & Tilkemeier, P.L. (1999). Neuropsychological functioning among cardiac rehabilitation patients. Journal of Cardiopulmonary Rehabilitation, 19, 91–97.Google Scholar
Muldoon, M.F., Flory, J.D., & Ryan, C.M. (2001). Serum cholesterol, the brain and cognitive functioning. In S.R. Waldstein & M.F. Elias (Eds.), Neuropsychology of Cardiovascular Disease (pp. 37–59). Mahwah, NJ: Lawrence Erlbaum Associates.
Murkin, J.M., Newman, S.P., Stump, D.A., & Blumenthal, J.A. (1995). Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. The Annals of Thoracic Surgery, 59, 1289–1295.Google Scholar
Rankin, K.P., Kochamba, G.S., Boone, K.B., Petitti, D.B., & Buckwalter, J.G. (2003). Presurgical cognitive deficits in patients receiving coronary artery bypass graft surgery. Journal of the International Neuropsychological Society, 9, 913–924.Google Scholar
Rankin, S.H. (2002). Women recovering from acute myocardial infarction: Psychosocial and physical functioning outcomes for 12 months after acute myocardial infarction. Heart & Lung: Journal of Critical Care, 31, 399–410.Google Scholar
Rosengart, T.K., Sweet, J., Finnin, E.B., Wolfe, P., Cashy, J., Hahn, E., Marymont, J., & Sanborn, T. (2005). Neurocognitive functioning in patients undergoing coronary artery bypass graft surgery or percutaneous coronary intervention: Evidence of impairment before intervention compared with normal controls. The Annals of Thoracic Surgery, 80, 1327–1335.Google Scholar
Ryan, C.M. (2001). Diabetes-associated cognitive dysfunction. In S.R. Waldstein & M.F. Elias (Eds.), Neuropsychology of Cardiovascular Disease (pp. 61–82). Mahwah, NJ: Lawrence Erlbaum Associates.
Screeche-Powell, C. & Owen, S. (2003). Early experiences of patients waiting to be accepted for CABG. British Journal of Nursing, 12, 612–619.Google Scholar
Selnes, O.A., Grega, M.A., Borowicz, L.M., Jr., Royall, R.M., McKhann, G.M., & Baumgartner, W.A. (2003). Cognitive changes with coronary artery disease: A prospective study of coronary artery bypass graft patients and nonsurgical controls. The Annals of Thoracic Surgery, 75, 1377–1386.Google Scholar
Spreen, O. & Strauss, E.A. (1998). Compendium of Neuropsychological Tests: Administration, Norms and Commentary. New York, NY: Oxford Press.
SPSS for Windows, Rel. 13.0. (2004). Chicago: SPSS Inc.
Strik, J.J., Honig, A., Lousberg, R., & Denollet, J. (2001). Sensitivity and specificity of observer and self-report questionnaires in major and minor depression following myocardial infarction. Psychosomatics, 42, 423–428.Google Scholar
Tsushima, W.T., Johnson, D.B., Lee, J.D., Matsukawa, J.M., & Fast, K.M.S. (2005). Depression, anxiety and neuropsychological test scores of candidates for coronary artery bypass graft surgery. Archives of Clinical Neuropsychology, 20, 667–673.Google Scholar
Turrell, G., Lynch, J.W., Kaplan, G.A., Everson, S.A., Helkala, E.L., Kauhanen, J., & Salonen, J.T. (2002). Socioeconomic position across the lifecourse and cognitive function in late middle age. The Journal of Gerontology. Series B, Psychological Sciences and Social Sciences, 57, S43–51.Google Scholar
Vingerhoets, G., de Soete, G., & Jannes, C. (1995). Relationship between emotional variables and cognitive test performances before and after open-heart surgery. Clinical Neuropsychologist, 9, 198–202.Google Scholar
Vingerhoets, G., Van Nooten, G., & Jannes, C. (1997). Neuropsychological impairment in candidates for cardiac surgery. Journal of the International Neuropsychological Society, 3, 480–484.Google Scholar
Waldstein, S.R. & Katzel, L.I. (2001). Hypertension and cognitive function. In S.R. Waldstein & M.F. Elias (Eds.), Neuropsychology of Cardiovascular Disease (pp. 15–36). Mahwah, NJ: Lawrence Erlbaum Associates.
Waldstein, S.R., Snow, J., Muldoon, M.F., & Katzel, L.I. (2001). Neuropsychological consequences of cardiovascular disease. In R.E. Tarter, M. Butters, & S.R. Beers (Eds.), Medical Neuropsychology (pp. 51–83). New York: Kluwer Academic/Plenum Publishers.
Yu, B.H., Nelesen, R., Ziegler, M.G., & Dimsdale, J.E. (2001). Mood states and impedance cardiography-derived hemodynamics. Annals of Behavioral Medicine, 23, 21–25.Google Scholar
Zigmond, A.S. & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.Google Scholar
Zuccala, G., Cattel, C., Manes-Gravina, E., Di Niro, M.G., Cocchi, A., & Bernabei, R. (1997). Left ventricular dysfunction: A clue to cognitive impairment in older patients with heart failure. Journal of Neurology Neurosurgery and Psychiatry, 63, 509–512.Google Scholar