Cognitive trajectories after postoperative delirium
Department of Medicine, Division of Geriatric Medicine; Department of Quantitative Health Sciences; Meyers Primary Care Institute
Medical Subject Headings
Aged; Aged, 80 and over; Cognition Disorders; *Coronary Artery Bypass; Delirium; Female; *Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; *Postoperative Complications; Prospective Studies; Psychiatric Status Rating Scales
Geriatrics | Health Services Research | Primary Care
BACKGROUND: Delirium is common after cardiac surgery and may be associated with long-term changes in cognitive function. We examined postoperative delirium and the cognitive trajectory during the first year after cardiac surgery.
METHODS: We enrolled 225 patients 60 years of age or older who were planning to undergo coronary-artery bypass grafting or valve replacement. Patients were assessed preoperatively, daily during hospitalization beginning on postoperative day 2, and at 1, 6, and 12 months after surgery. Cognitive function was assessed with the use of the Mini-Mental State Examination (MMSE; score range, 0 to 30, with lower scores indicating poorer performance). Delirium was diagnosed with the use of the Confusion Assessment Method. We examined performance on the MMSE in the first year after surgery, controlling for demographic characteristics, coexisting conditions, hospital, and surgery type.
RESULTS: The 103 participants (46%) in whom delirium developed postoperatively had lower preoperative mean MMSE scores than those in whom delirium did not develop (25.8 vs. 26.9, P
CONCLUSIONS: Delirium is associated with a significant decline in cognitive ability during the first year after cardiac surgery, with a trajectory characterized by an initial decline and prolonged impairment. (Funded by the Harvard Older Americans Independence Center and others.).