Skip to main content
SpringerLink
Log in

Pre-operative mild cognitive dysfunction predicts risk for post-operative delirium after elective cardiac surgery

  • Original Articles
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background and Aims: To identify pre-operative risk factors for delirium in patients undergoing elective cardiac surgery, using clearly defined diagnostic criteria for delirium, and a thorough clinical assessment. Methods: The incidence of post-operative delirium in 107 patients ≥60 years undergoing elective cardiac surgery was calculated. None of the patients included suffered from dementia. Pre-operative cognitive function in all patients was assessed using the Mini Mental State Examination (MMSE) and post-operative delirium was diagnosed using the Confusion Assessment Method (CAM). Post-operative clinical and cognitive assessments were carried out for all patients. Results: Twenty-five patients (23.4%) developed delirium post-operatively. Clinical parameters, including age, gender, co-morbidities, medications, and peri-operative parameters, were similar in patients with and without post-operative delirium. Patients with pre-operative subjective memory complaints and lower MMSE scores, undergoing valve operation or valve + coronary artery bypass grafting (CABG), exhibited an increased risk of developing post-operative delirium. Additionally, delirious patients had a significant decline in post-operative MMSE score compared with the non-delirious ones. Conclusions: The main pre-operative risk factors for post-operative delirium after elective cardiac operations were subjective memory complaints, mild cognitive impairment, and type of cardiac surgery, such as valve procedures. This study suggests that cognitive evaluation should be included in pre-operative assessment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Jellinger KA. Delirium in old age. Euro J Neurol 2003; 10: 194–5.

    Google Scholar 

  2. Smith LW, Dimsdale JE. Postcardiotomy delirium: conclusions after 25 years? Am J Psychiatry 1989; 146: 452–8.

    PubMed  CAS  Google Scholar 

  3. van der Mast RC, Roest FH. Delirium after cardiac surgery: a critical review. J Psychosom Res 1996; 41: 13–30.

    Article  PubMed  Google Scholar 

  4. Walzer T. Herrmann M. Wallesch CW. Neuropsychological disorders after coronary bypass surgery. J Neurol Neurosurg Psychiatry 1997; 62: 644–8.

    Article  CAS  Google Scholar 

  5. van der Mast RC, van den Broek WW, Fekkes D, Pepplinkhuizen L, Habbema J. D. Incidence of and preoperative predictors for delirium after cardiac surgery. J Psychosom Res 1999; 46: 479–83.

    Article  Google Scholar 

  6. Eriksson M, Samuelsson E, Gustafson Y, Aberg T, Engstrom KG. Delirium after coronary bypass surgery evaluated by the organic brain syndrome protocol. Scand Cardiovasc J 2002; 36: 250–5.

    Article  PubMed  Google Scholar 

  7. Ahlgren E, Arén C. Cerebral complications after coronary artery bypass and heart valve surgery: risk factors and onset of symptoms. J Cardioth Vasc Anesth 1998; 12: 270–3.

    Article  CAS  Google Scholar 

  8. Rolfson DB, McElhaney JE, Rockwood K, et al. Incidence and risk factors for delirium and other adverse outcomes in older adults after coronary artery bypass graft surgery. Can J Cardiol 1999; 15: 771–6.

    PubMed  CAS  Google Scholar 

  9. Savageau JA, Stanton BA, Jenkins CD, Klein MD. Neuropsychological dysfunction following elective cardiac operation. I. Early assessment. J Thorac Cardiovasc Surg 1982; 84: 585–94.

    CAS  Google Scholar 

  10. Selnes OA, Goldsborough, MA, Borowicz LM, Enger C, Quaskey SA, McKhann GM. Determinants of cognitive change after coronary artery bypass surgery: a multifactorial problem. Ann Thorac Surg 1999; 67: 1669–76.

    Article  PubMed  CAS  Google Scholar 

  11. Selnes OA, Goldsborough, MA, Borowicz LM, McKhann GM. Neurobehavioural sequelae of cardiopulmonary bypass. Lancet 1999; 353: 1601–6.

    Article  PubMed  CAS  Google Scholar 

  12. Murkin JM. Etiology and incidence of brain dysfunction after cardiac surgery. J Cardiothorac Vasc Anesth 1999; 13: 12–7.

    PubMed  CAS  Google Scholar 

  13. Hammon JW Jr, Stump DA, Kon ND, et al. Risk factors and solutions for the development of neurobehavioral changes after coronary artery bypass grafting. Ann Thorac Surg 1997; 63: 1613–7.

    Article  PubMed  Google Scholar 

  14. Gokgoz L, Gunaydin S, Sinci V, et al. Psychiatric complications of cardiac surgery. Postoperative delirium syndrome. Scand Cardiovasc J 1997; 31: 217–22.

    Article  CAS  Google Scholar 

  15. Ebert AD, Waltzer TA, Huth C, Herrmann M. Early neurobehavioral disorders after cardiac surgery: a comparative analysis of coronary artery bypass graft surgery and valve replacement. J Cardiothorac Vasc Anesth 2001; 15: 15–9.

    Article  PubMed  CAS  Google Scholar 

  16. Litaker D, Locala J, Franco K, Bson DL, Tannous MD. Preoperative risk factors for postoperative delirium. Gen Hosp Psychiatry 2001; 23: 84–9.

    Article  PubMed  CAS  Google Scholar 

  17. Wolman RL, Nussmeier NA, Aggarwal A, et al. Cerebral injury after cardiac surgery. Identification of a group at extraordinary risk. Stroke 1999; 30: 514–22.

    CAS  Google Scholar 

  18. Roach GW, Kanchuger M, Mora Mangano C, et al. Adverse cerebral outcomes after coronary bypass surgery. New Engl J Med 1996; 335: 1857–64.

    Article  PubMed  CAS  Google Scholar 

  19. Millar K, Asbury AJ, Murray GD. Pre-existing cognitive impairment as a factor influencing outcome after cardiac surgery. Br J Anaesth 2001; 86: 63–7.

    Article  PubMed  CAS  Google Scholar 

  20. van Dijk D, Keiser AMA, Diephuis JC, Durand C, Vos LJ, Hijman R. Neurocognitive dysfunction after coronary artery bypass surgery: a systematic review. J Thorac Cardiovasc Surg 2000; 120: 632–9.

    Article  PubMed  Google Scholar 

  21. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz R. Clarifying confusion: the Confusion Assessment Method. A new method for detection of delirium. Ann Intern Med 1990; 113: 941–8.

    Article  CAS  Google Scholar 

  22. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. 3rd rev ed. (DSM-III-R) (Washington, DC, APA 1987).

  23. Campeau L. Grading of angina pectoris. Circulation 1976; 54: 522–23.

    PubMed  CAS  Google Scholar 

  24. Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatry 1975; 12: 189–98.

    CAS  Google Scholar 

  25. Olin K, Eriksdotter Jönhagen M, Jansson A, Herrington MK, Kristiansson M, Permert J. Postoperative delirium in elderly patients after abdominal surgery. British J Surgery 2005; 92: 1559–64.

    Article  CAS  Google Scholar 

  26. Braekken SK, Reinvag I, Russell D, Brucher R, Svennevig JL. Association between intraoperative cerebral microembolic signals and postoperative neuropsychological deficit: comparison between patients with cardiac valve replacement and patients with coronary artery bypass grafting. J Neurol Neurosurg Psychiatry 1998; 65: 573–6.

    Article  PubMed  CAS  Google Scholar 

  27. Ganushchak YM, Fransen EJ, Visser C, de Jong DS, Maessen JG. Neurological complications after coronary artery bypass grafting related to the performance of cardiopulmonary bypass. Chest 2004; 125: 2196–205.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. Neurobiology, Caring Sciences and Society, Division of Clinical Geriatrics, Karolinska University Hospital, , Huddinge B 56, S-141 86, Stockholm, Sweden

    Graciela Veliz-Reissmüller, Hedda Agüero Torres & Maria Eriksdotter Jönhagen MD, PhD

  2. Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Jan van der Linden & Dan Lindblom

Authors
  1. Graciela Veliz-Reissmüller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hedda Agüero Torres
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jan van der Linden
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dan Lindblom
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Eriksdotter Jönhagen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Eriksdotter Jönhagen MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Veliz-Reissmüller, G., Torres, H.A., van der Linden, J. et al. Pre-operative mild cognitive dysfunction predicts risk for post-operative delirium after elective cardiac surgery. Aging Clin Exp Res 19, 172–177 (2007). https://doi.org/10.1007/BF03324686

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03324686

Keywords

Search

Navigation