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The Journal of Thoracic and Cardiovascular Surgery, Vol 84, 595-600, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JA Savageau, BA Stanton, CD Jenkins and RW Frater
Three neuropsychological tests were administered to 245 men and women, ages
25 to 69 years, before and 6 months after coronary bypass and cardiac valve
operations to provide current information regarding the incidence of
long-term postoperative decrements in neuropsychological function and the
factors associated with them. Biographical, psychological and
medical-surgical data were studied together with changes on the Trail
Making Test from the Halstead-Reitan Battery, and Visual Reproduction (VR)
and Logical Memory tests, both from the Wechsler Memory Scale (WMS).
Although 28% of this group showed a deterioration in one or more test
scores at a 9 day postoperative examination as compared to their
preoperative scores, over 80% of these patients had returned to normal
range by 6 months. Similarly, the majority of the 19% of patients showing a
significant decrease in one or more of four scores at 6 months had incurred
their performance decrements subsequent to the 9 day examination. Hence it
seems inappropriate to attribute these latter dysfunctions to the surgical
epidose per se, as others have reported. Only 5% of patients showed
consistent postoperative test score deterioration both at 9 days and 6
months. Decrements of function at 6 months appear to be associated with
total estimated blood loss greater than 3,000 ml and administration of
propranolol during the operation plus several postoperative factors
including higher levels of fatigue, depression, and worries related to the
operation and the recovery process. These findings underscore the need for
clinicians and investigators studying neuropsychological dysfunction
following cardiac operations to take concurrent emotional and physical
states into account, and to make repeated measures well separated in time,
before interpreting the presence or absence of residual neuropsychological
problems.
ARTICLES
Neuropsychological dysfunction following elective cardiac operation. II. A six-month reassessment
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