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A syndromal analysis of neuropsychological outcome following coronary artery bypass graft surgery
- Source :
- Journal of Neurology, Neurosurgery & Psychiatry. 76:1121-1127
- Publication Year :
- 2005
- Publisher :
- BMJ, 2005.
-
Abstract
- Background: Studies of neuropsychological outcome following coronary artery bypass graft surgery (CABG) have traditionally dichotomised patients as "impaired" or "unimpaired". This conceals the potential heterogeneity of deficits due to different mechanisms and sites of brain injury. Objectives: To explore neuropsychological outcome following CABG and determine to what extent it conforms to prototypic cortical and/or subcortical neurobehavioral syndromes and whether different intraoperative physiologic measures are associated with different subtypes of neuropsychological outcome. Methods: Neuropsychological tests were administered to 85 patients before and after elective CABG and to 50 matched normal control subjects. Pre- to postoperative change scores were computed using standardised regression based norms. Change scores on selected memory measures were subjected to cluster analysis to identify qualitatively distinct subtypes of memory outcome. Emergent clusters were compared on non-memory measures, intraoperative physiologic measures, and demographic variables. Results: Three subtypes of memory outcome were identified: memory spared (48% of patients), retrieval deficit (35%), and encoding/storage deficit (17%). Contrary to expectation, the subgroups were indistinguishable on measures of confrontation naming and manual dexterity and on intraoperative cardiac surgical physiologic measures and demographic variables. The encoding/storage deficit subgroup exhibited executive dysfunction. Conclusions: Heterogeneous profiles of neuropsychological dysfunction were found following CABG although they did not tightly conform to prototypic cortical and subcortical neurobehavioral syndromes. This challenges the value and appropriateness of the common practice of collapsing individual test scores to arrive at a single figure to define "impairment". Whether different subtypes of neuropsychological outcome are caused by different pathophysiologic mechanisms remains unknown.
- Subjects :
- Male
Paper
medicine.medical_specialty
Coronary Artery Disease
Neuropsychological Tests
Severity of Illness Index
Outcome (game theory)
Coronary artery disease
Postoperative Complications
Severity of illness
Cluster Analysis
Humans
Medicine
Coronary Artery Bypass
Stroke
Aged
Depressive Disorder, Major
business.industry
Neuropsychology
medicine.disease
Surgery
Psychiatry and Mental health
surgical procedures, operative
medicine.anatomical_structure
Elective Surgical Procedures
Regression Analysis
Female
Neurology (clinical)
Cognition Disorders
Elective Surgical Procedure
business
Executive dysfunction
Artery
Subjects
Details
- ISSN :
- 00223050
- Volume :
- 76
- Database :
- OpenAIRE
- Journal :
- Journal of Neurology, Neurosurgery & Psychiatry
- Accession number :
- edsair.doi.dedup.....a466592c1532c84eb159138f221a2d1a