COGNITIVE ISSUES-THEY ARE EVERYWHERE

The following article appeared in Medical News Today which is one of the many news feeds that distract me from getting a damn thing done on any given day of the week.  I know, as one of those always popular, can't ever implement "work around solutions" I should be scheduling internet time into my day.  I think I may have to force myself to borrow one of the programs they use to set up student schedules.  You remember?  That paper you would get the beginning of each high school year, the one that, invariably would find me searching for my gym class (ahem.... I mean PE) to make sure I would not be spending half of my day looking like a hot* mess because PE was smack in the midst of things.

This study talks about cognitive issues in elderly heart surgical patients.  In my most non-scientific, sometimes well oiled (but mostly another hot mess) brain, I have to believe that all of this is somehow connected.  I'll get this article over to my good pal, Bud Abbott (aka Idelle Davidson) since she always seems to be better able to pick apart this information.  It seems to me there are a number of issues being studied regarding cognitive issues but they are always within a particular population subset.  Something is trying to break through my thought process but I can't quite grasp the thought much less verbalize the concept but the brain is an organ and it is the least understood organ in our bodies.

Maybe we need to put all of these cognitive studies in front of the same group of very analytical eyes so they can see where the commonality lies?  Maybe they will brainstorm their way toward one key item that may unlock many answers?  I don't know.  I'm just the one with the rearranged brain throwing out ideas.

As for *hot* mess.  I meant, a true mess of sweatiness who either skipped PE altogether unless we were outdoors doing something like archery OR skipped out of the remainder of my afternoon classes rather than walk around school as the girl in need of a shower who refused to use the locker room.

While this study concentrates on delirium as the precursor, do you recall the recent study where it was mentioned that a cancer diagnosis "in and of itself" might trigger our chemobrains?  Few faced with the shock of a cancer diagnosis and the gazillion ensuing appointments, particularly in those first days and weeks after the diagnosis, want to hear about what might happen to their cognitive function.  Speaking for myself, I'm fairly certain I would NEVER have been able to sit for the three hour assessment.  I know me.  I would have been thinking, "Who CARES about how forgetful I might become, who cares if I can't work in my chosen field, I just want this cancer thing FIXED."  And, even if I were able to grasp the potential enormity of long term and/or later onset issues to actually sit for an assessment, I'm going out on a limb here: NO way would I be able to focus on any test.  No matter what flashed on the screen or how the word green may have been spelled using blue ink to screw with my brain, the only thing I would have seen?  Cancer.  Cancer.  Breast Cancer.  Cancer. Will I die?  Is my hair going to fall out?  (Because, admit it, that IS one of the first questions that pops into our heads) Cancer.  CANCER????  Losing my hair would have been a HUGE deal.  Apparently, the loss of my brain...... never even crossed my mind........

Here's the piece from MNT.  It can also be found in Science Daily.  Emphasis is mine.

Preventing Postoperative Delirium May Improve Recovery Of Cognitive Ability In Cardiac Patients

Article Date: 06 Jul 2012 - 1:00 PDT

Older patients undergoing cardiac surgery often experience changes in cognitive function, such as memory problems or an inability to focus, in the days immediately following their operations. While these changes are usually temporary, for unknown reasons, a significant number of cardiac patients will encounter long-term cognitive problems, lasting as long as a year after their surgeries. 

Now, new research published in The New England Journal of Medicine (NEJM), establishes a link between postoperative delirium and prolonged loss of cognitive function in cardiac surgery patients. Led by investigators at the University of Massachusetts Medical School, Beth Israel Deaconess Medical Center and the Aging Brain Center at Hebrew SeniorLife, the findings suggest that interventions to prevent delirium in advance of surgery could help cardiac patients avoid long-term cognitive consequences. 

A state of confusion that can develop following illness, infection or surgery, delirium is one of the most common complications in hospitalized patients over age 65. "Our findings now suggest that postoperative delirium, once thought of as an acute, transient cognitive disorder, may have longer-term effects on cognitive function in patients undergoing cardiac surgery," said co-lead author Jane Saczynski, PhD, assistant professor of medicine at the University of Massachusetts Medical School. 

While delirium has been studied quite extensively in other patient populations, including general medical and surgical patients and orthopedic surgery patients, few studies of delirium have targeted cardiac surgery patients. "With the aging of the patient population undergoing cardiac surgery and increases in survival after surgery, clinicians and patients are increasingly concerned with factors associated with quality of life, including cognitive status, as major outcomes of surgery," the authors write. "Whether postoperative delirium is associated with prolonged cognitive dysfunction has been unclear." 

The researchers followed 225 patients, aged 60 to 90, who underwent either coronary artery bypass grafting (CABG) or heart valve replacement surgery at Beth Israel Deaconess Medical Center (BIDMC), UMass Memorial Medical Center or the Boston VA Medical Center, for one year after their surgeries, assessing them for both delirium and cognitive impairment. 

"One of the real strengths of our study is that we assessed patients' cognitive function preoperatively and an average of five times during the year after surgery," said co-lead author Edward Marcantonio, MD, section chief for research in BIDMC's Division of General Medicine and Primary Care and professor of medicine at Harvard Medical School. "Previous research had shown an association between postoperative delirium and functional decline in activities of daily living [such as grooming and dressing, driving, shopping, preparing meals and managing medications and finances.] But, believe it or not, the one thing that's been most uncertain is the association between delirium and long-term cognitive difficulties. This study allowed us to accurately model the course of cognitive function and to compare the rate of recovery among patients with and without postoperative delirium." 

The results showed that compared with patients who did not experience delirium, the 103 patients who developed delirium after cardiac surgery - 46 percent of the total - experienced a more significant drop in cognitive performance immediately following surgery, as determined by the Mini-Mental State Examination (MMSE). They also took significantly longer to recover back to their pre-surgical level of function than did patients who did not develop delirium. For example, five days after surgery, nearly half of those who did not develop delirium had returned to pre-operative levels of function while less than 20 percent of those who did develop delirium had returned to pre-operative level of function; six months after surgery, more than three-quarters of those without delirium had recovered cognitively compared to only 60 percent of those with delirium. 

Although patients who developed delirium took longer to recover to their pre-operative levels of cognitive performance, they continued to improve in the weeks and months after surgery. Cognitive performance reached preoperative levels and stabilized one month after surgery in patients who did not develop delirium but continued to improve until six months after surgery in those with delirium. 

These findings suggest that identifying patients at high risk for delirium prior to surgery and promoting the use of interventions to prevent delirium in cardiac surgical patients may have substantial benefits. It could improve the recovery rate of cognitive abilities and enhance functional recovery following surgery. 

Further cognitive screening at discharge may also identify patients who require closer, post-operative monitoring or tailored transitional care to enhance the return of cognitive functions. "Since patients who experience delirium continue to show improvement in cognitive function six months after surgery, extending additional rehabilitation services to these patients may have added benefits," said co-senior author Richard N. Jones, ScD, director of mental health and aging at Hebrew SeniorLife and assistant professor of medicine at Harvard Medical School. 

"The findings from this study highlight the clinical importance of the identification of delirium and the potential of preventive interventions like the Hospital Elder Life Program [HELP]," said co-senior author Sharon K. Inouye, MD, MPH, director of the Aging Brain Center at Hebrew SeniorLife and professor of medicine at Harvard Medical School. "Although it is possible to identify patients at high risk for developing delirium and preventive interventions for delirium exist, these interventions have not been well tested in patients undergoing cardiac surgery. Additional development and testing of these interventions need to be studied in this patient population to accurately assess the potential benefits for cardiac patients." 

"More than half a million heart surgeries are performed each year," said Marcantonio. "Our findings provide important information that might help doctors design interventions to improve the outcomes of older adults undergoing cardiac surgeries."

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References:
Support for this study was provided by grants from the Harvard Older Americans Independence Center (P60AG008812), the National Institute on Aging (K01AG33643, to Dr. Saczynski), the National Heart, Lung, and Blood Institute (U01HL105268, to Dr. Saczynski), and the National Institute on Aging (R01AG030618, to Dr. Marcantonio, and P01AG031720, to Dr. Inouye), and by a National Institutes of Health (NIH) Mid-Career Investigator Award (K24AG035075, to Dr. Marcantonio) and an NIH Translational Research in Aging fellowship (T32 AG023480, to Dr. Gross).
University of Massachusetts Medical School

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Citations:

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

University of Massachusetts Medical School. "Preventing Postoperative Delirium May Improve Recovery Of Cognitive Ability In Cardiac Patients." Medical News Today. MediLexicon, Intl., 6 Jul. 2012. Web.
6 Jul. 2012.

APA

University of Massachusetts Medical School. (2012, July 6). "Preventing Postoperative Delirium May Improve Recovery Of Cognitive Ability In Cardiac Patients." Medical News Today. Retrieved from
http://www.medicalnewstoday.com/releases/247474.php.

Please note: If no author information is provided, the source is cited instead.

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