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PubMed1989

Transurethral prostatectomy: differential effects of age category and presurgery sexual functioning on postprostatectomy sexual adjustment.

Sexual functioning and adjustment of 72 aging married males who had undergone transurethral prostatectomy were examined retrospectively according to their pre- and postsurgery status. Results indicate that although transurethral prostatectomy was generally associated with deterioration in various aspects of sexual expression, grouping subjects according to age and presurgery sexual adjustment qualified these general findings dramatically. For example, more younger than older males retained or attained good sexual adjustment after surgery. Furthermore, while older males with good presurgery sexual adjustment maintained good couple sexual functioning, they manifested greater loss of sexual self-confidence and individual sexual capacity than did their younger counterparts. In addition, the findings suggest that the question "Does transurethral prostatectomy affect sexual function?" must be rephrased to take into account changes in the cognitive, capacity, and affective domains as well as in the couple behavior and adjustment dimensions of sexual expression.

Aged↗

PubMed2002

Outcomes after the Fontan procedure.

Over the past two decades, advances in congenital heart surgery, pediatric cardiology, and intensive care medicine have dramatically increased the survival of infants with critical congenital heart disease. The group of patients that has perhaps benefited the most from this progress has been the single-ventricle population. Staged palliation culminating in the Fontan procedure has resulted in a decreasing mortality rate and an increase in the number of single-ventricle survivors. Over the past 18 months, many studies have focused on outcomes after the Fontan procedure. These reports demonstrate progressive improvement in early postoperative survival and intermediate and late postoperative outcomes due to surgical innovations, such as the lateral tunnel and extracardiac Fontan modifications, and fenestration, as well as technological improvements, such as modified ultrafiltration. Despite these improvements, significant morbidity remains after the Fontan completion, including myocardial systolic and diastolic dysfunction, systemic arterial and venous hemodynamic abnormalities, diminished exercise capacity, arrhythmias, protein-losing enteropathy, somatic growth retardation, neo-aortic valve root dilation and insufficiency, thromboembolic complications, and below-average cognitive development.

Age Factors↗

PubMedDate not supplied

Serial cognitive testing in temporal lobe epilepsy: longitudinal changes with medical and surgical therapies.

Cognitive testing was repeated at intervals ranging from 1 to 8 years in 47 adult patients with temporal lobe epilepsy (TLE). Each patient underwent standardized batteries, including the Wechsler Adult Intelligence Scale, Revised (WAIS-R), and Wechsler Memory Scale (WMS). Both surgically treated and nonsurgical patients were examined. The nonsurgical group underwent serial testing for clinical indications, usually for complaints of memory dysfunction. Longitudinal testing could not verify any mean deterioration of intellect or memory in this group; variance over time was similar to test-retest norms in healthy controls. WAIS-R scores before and after resection in the surgical group were similar to our serial WAIS-R data in nonsurgical patients. When we divided surgical patients according to side of epileptogenesis, we noted the expected differences in verbal and visual memory. Right-sided surgery patients improved significantly in Full-Scale IQ (FSIQ) and tended to improve in logical memory on postoperative testing. Patients undergoing left resections had no retest improvement and tended to show decrease in several measures of verbal memory. Our findings should stimulate continued investigation into the natural history of lateralized memory and intellectual function in epilepsy, particularly to clarify long-term cognitive outcome in nonsurgical patients.

Adult↗

PubMed1991

Long-term cognitive deficits in patients after surgery on aneurysms of the anterior communicating artery.

The long term recovery of a series of 27 patients who had undergone rupture and repair of an aneurysm of the anterior communicating artery was assessed using a number of neuropsychological measures. Testing took place 12 to 84 months post surgery. On the basis of the results from tests of intellect, memory, and conceptual learning, three subgroups of patients were identified: those with persuasive cognitive defects, those with evidence of residual frontal lobe damage and those who showed no evidence of dysfunction. The occurrence of cerebral vasospasm was the most consistent predictor of long term cognitive deficit.

Adult↗

PubMed1994

Long-term effects of radiation for medulloblastoma on intellectual and physical development. A case report of monozygotic twins.

BACKGROUND: Recent advances in treatment have improved the prognosis for medulloblastoma. Although postoperative radiation of the central nervous system (CNS) is widely practiced, late radiation sequelae, especially in long-term survivors, pose a constant risk. METHODS: To assess the long-term effects of CNS radiation, a monozygotic twin girl with medulloblastoma was compared with her normal twin. Treatment included total removal of the mass, postoperative chemotherapy, and CNS radiation with 47.8 Gy directed to the posterior fossa, 30.2 Gy to the cerebral hemispheres, and 20 Gy to the whole spine. RESULTS: Not only the radiated patient's spine but also the unradiated upper and lower limbs were shorter than the control subject's. The patient's thyroid hormone level was within normal range; however, thyroid-stimulating hormone was higher than normal. The patient's intellectual ability deteriorated, and cognitive dysfunction has not improved as of 6 years after treatment. CONCLUSIONS: Treatment systems that do not cause late sequelae affecting physical and intellectual development should be pursued.

Body Height↗

PubMed2004

Effect of tacrolimus (FK506) on ischemia-induced brain damage and memory dysfunction in rats.

The behavioral and neurohistological protective effects of tacrolimus (FK506) were examined in rats subjected to 15-min global forebrain ischemia. Learning and memory performance were evaluated in an aversive, non-food-motivated, eight-arm radial maze. In one experiment, naive rats were rendered ischemic, and 15 days later they were tested for acquisition of a spatial task (postoperative training). In a complementary experiment, rats were trained for 8 days and then subjected to ischemia (preoperative training); 15 days later (on Day 24 of testing) they were retested for retention of cognition. FK506 (1.0 mg/kg) was given intravenously at the beginning of reperfusion, followed by doses applied intraperitoneally 6, 24, 48 and 72 h postischemia. Behavioral performance was expressed by latency to find the goal box, and number of errors. Ischemia did not affect acquisition performance. In contrast, retention of cognition was markedly impaired by ischemia, particularly working memory (P<.05-.001). This ischemia-induced, retrograde amnesia was significantly reduced by FK506 compared to vehicle alone on Day 24, as measured by latency and working memory errors (P<.025). A neuroprotective effect of FK506 was also seen on working memory, when postischemic performance was compared to that prior to ischemia (P>.05, Day 24 vs. Day 8, paired samples), in contrast to the significant, retrograde amnesia found in the ischemic, vehicle-treated group (P<.01). FK506 also significantly reduced the extent of hippocampal CA1 cell loss; however, this effect did not correlate with behavior. The present results suggest that the histological, neuroprotective effect of FK506 may be accompanied by a reduction in cognitive impairment, as assessed in a novel, non-food-motivated, eight-arm radial maze after transient, global, cerebral ischemia in rats.

Animals↗

PubMed2004

Organic and psychogenic factors leading to executive dysfunctions in a patient suffering from surgery of a colloid cyst of the Foramen of Monro.

The authors report a 41-year-old female patient who had suffered from colloid cyst of the Foramen of Monro. After surgical intervention in which the cyst was completely removed, her hydrocephalus decreased to normal ventricle size measured by MRI. However, the patient became depressive and reported vast difficulties in everyday life decision-making. An examination twenty months after surgery indicated psychiatric symptoms and abnormalities in personality. Neuropsychological investigation revealed average to above average performance in anterograde memory, attention, information processing, and intelligence. In contrast, the patient was severely impaired in decision-making, complex executive functions, and social cognition. In 18F-2-fluoro-2-deoxy-D-glucose (18FDG-PET) hypometabolism in bilateral dorsolateral prefrontal cortex, cingulate cortex and left fusiform gyrus was observed. The authors conclude that in this case decision-making deficits and executive dysfunctions are influenced by both organic and psychogenic factors.

Adult↗

PubMed2005

Management of referred deep brain stimulation failures: a retrospective analysis from 2 movement disorders centers.

BACKGROUND: Since the Food and Drug Administration approved DBS, there has been a surge in the number of centers providing the procedure. There is currently no consensus regarding appropriate screening procedures, necessary training of individuals providing the therapy, the need for an interdisciplinary team, or guidelines for the management of complications. An increasing number of patients come to experienced DBS centers after unsatisfactory results from DBS surgery. An attempt is made herein to evaluate the reasons for DBS failure in a series of such patients and to make recommendations to improve overall DBS outcomes. OBJECTIVE: To improve outcomes of deep brain stimulation (DBS) surgery by analyzing a series of patients who had suboptimal results from DBS. METHODS: Forty-one consecutive patients complaining of suboptimal results from DBS surgery came to the University of Florida Movement Disorders Center, or to Beth Israel Movement Disorders Center, over a 24-month period. All patients had undergone implantation of DBS devices at outside medical centers. Each patient was evaluated by a movement disorders neurologist, and the complete medical record was reviewed. The DBS device for each patient was interrogated for adverse effects and programmed for maximal benefit. Postoperative imaging studies were evaluated whenever possible. RESULTS: The average age of patients was 63.4 years (range, 49-84 years). The indication for surgery (by record review) included 9 patients with essential tremor, 31 with Parkinson disease, and 1 with dystonia. The diagnoses after referral examination included 5 with essential tremor, 26 with Parkinson disease, 3 with Parkinson disease and dementia, 1 with Parkinson disease and essential tremor, 1 with corticobasal degeneration, 1 with dystonia, 2 with multiple system atrophy, 1 with progressive supranuclear palsy, and 1 with myoclonus. Issues related to inadequate preoperative screening: Thirty (73%) of 41 patients saw a movement disorders specialist prior to DBS implantation. Fourteen (34%) patients had neuropsychological testing, 4 (10%) did not have testing, and in 23 cases (56%), it could not be determined whether or not they were tested. Five (12%) of 41 patients had an inadequate medication trial, and 5 patients (12%) had significant cognitive dysfunction prior to their DBS implantation. Surgical and device-related complications: Nineteen (46%) of 41 patients had suboptimally placed electrodes. Seven electrodes (17%) were replaced with improvement. Three patients' devices had failed due to end of battery life, 2 had infections, and 1 had a fractured lead. Programming and medication adjustments: Seven (17%) of 41 patients had no or poor access to programming. Two patients (5%) moved, and 2 physicians (5%) moved, creating issues with access to care. Eight patients (20%) required local follow-up (they flew to remote centers to have the surgery performed). Fifteen patients (37%) were inadequately programmed and improved significantly with reprogramming. Six patients (15%) experienced partial improvement with reprogramming, and 21 patients (51%) failed to improve despite extensive reprogramming. Thirty patients (73%) benefited from medication changes, 4 (10%) had antidepressants added to their regimens, and 1 (2%) had donepezil hydrochloride added. One patient's carbidopa/levodopa (2%) was restarted after complete discontinuation. OUTCOMES: With the various postoperative interventions described, 21 (51%) of 41 patients had good outcomes, 6 (15%) had modest clinical improvement, and 14 (34%) did not improve. CONCLUSIONS: With appropriate intervention, 51% of patients who complained of "failed" DBS procedures ultimately had good outcomes. Thirty-four percent of these patients had persistently poor outcomes despite maximal intervention. This case series provides important insights into reasons for "DBS failure" and proposes strategies to manage patients with DBS more effectively.

Aged↗

PubMed1991

Aseptic meningitis following cardiac transplantation: clinical characteristics and relationship to immunosuppressive regimen.

Neurologic disorders are uncommon but alarming complications of cardiac transplantation. Of 29 patients from the Utah Cardiac Transplant Program (UCTP) who had lumbar puncture because of change in neurologic function, or to assess fever of uncertain etiology, CSF pleocytosis was present in 14 patients, 4 of whom had an active infectious process involving the nervous system. In 10 other patients, CSF pleocytosis with negative cultures appeared following treatment with OKT3 monoclonal antibody. The most prominent clinical signs of this aseptic meningitis syndrome are fever and transient cognitive dysfunction.

Adolescent↗

PubMed2003

Cognitive deficits in patients with hepatic cirrhosis and in liver transplant recipients.

This study assessed cognitive deficit in patients diagnosed with different stages of hepatic cirrhosis and in liver transplant recipients. A short protocol consisting of several psychometric tests was used. Cirrhotic patients showed a degree of mental impairment in all the functions studied. The severity of the deficit was related to the degree of hepatic dysfunction. In contrast, liver transplant recipients presented only a slightly altered cerebral dysfunction in comparison to the control group. Their cognitive capacity was slightly better than that of patients with asymptomatic cirrhosis.

Adult↗

PubMed2003

[Neuropathological effects of surgical treatment of coronary heart disease].

Recent improvement in surgical and anaesthetic techniques has significantly reduced the number of post-operative complications, including those from the CNS. Nevertheless the risk of cerebral complications after cardiac revascularization by means of coronary artery bypass grafting (CABG) still exists and is considered an important risk factor in cardiac surgery. Organic cerebral complications may manifest themselves in the form of relatively overt neurological symptoms, such as stroke (1-3%), dysfunction of peripheral nervous system (5-10%) or slight, more difficult to diagnose cognitive deficits (33 to 83%). Acute qualitative dysfunction of awareness develops in about 7-12% of patients shortly after surgery. Depression or anxiety syndromes are observed in about 25% of patients. Presented results inevitably suggest a necessity for programmed psychological assistance and counselling in this category of patients.

Coronary Artery Bypass↗

PubMed2005

The incidence of cognitive decline after (not) undergoing coronary artery bypass grafting: the impact of a controlled definition.

BACKGROUND: After coronary artery bypass grafting (CABG), 20-30% of patients are reported to suffer from cognitive decline. Studies reporting these high incidences, however, have not included an appropriate control group. METHODS: We repeatedly administered a series of neuropsychological tests to 112 healthy middle-aged volunteers not undergoing surgery, and applied two widely used definitions of cognitive decline to their test results. In addition, we re-analysed the neuropsychological test data of 281 CABG patients with a definition of cognitive decline that takes into account the natural variability of test performance that was found in the volunteers. RESULTS: Three months after their first assessment, 14-28% of the volunteers suffered from cognitive decline according to the definitions of cognitive decline after CABG. Using the controlled definition of cognitive decline that takes the natural variability in test performance into account, we found that only 7.7% of the CABG patients suffered from cognitive decline at 3 months after their operation. CONCLUSION: These data suggest that the incidence of cognitive dysfunction after CABG has previously been greatly overestimated.

Aged↗

PubMed1997

Magnetic resonance imaging and behavioral analysis of immature rats with kaolin-induced hydrocephalus: pre- and postshunting observations.

The motor and cognitive dysfunction associated with hydrocephalus remains a clinical problem in children. We hypothesized that young rats with hydrocephalus should exhibit similar dysfunction and that the dysfunction should be reversible by shunting. Hydrocephalus was induced in 3-week-old rats by injection of kaolin into the cisterna magna. Rats were assessed by T2-weighted images obtained with a 7-T magnetic resonance device and by repeated behavioral testing including ability to traverse a narrow beam and ability to find a hidden platform in a water pool. Some of the rats underwent a shunting procedure 1 or 4 weeks after kaolin injection. Magnetic resonance images were used to measure ventricle size. They clearly demonstrated increased signal in periventricular white matter, which corresponded to increased brain water content. A flow-void phenomenon was observed in the cerebral aqueduct. Ability to traverse the beam did not correlate with the degree of ventriculomegaly. Ability to swim to the hidden platform demonstrated a progressive impairment of learning function which may have been accentuated by motor disability. When rats were shunted after 1 week, the behavioral dysfunction was prevented. Late shunting after 4 weeks was associated with gradual recovery of the behavioral disability which was not complete after 4 weeks. We conclude that early shunting is superior to late shunting with regard to behavioral dysfunction. High-resolution MR imaging shows features in hydrocephalic rats similar to those found in hydrocephalic humans.

Animals↗

PubMed2003

Off-Pump versus on-pump coronary artery bypass: can OPCAB reduce neurologic injury?

OBJECTIVE: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass is still the gold standard for surgical myocardial revascularization. Despite advances in techniques and technologies, documented evidence indicates that cardiopulmonary bypass remains the major source of intraoperative brain injury. This study was set up to test whether offpump coronary artery bypass (OPCAB) is superior to CABG regarding postoperative neurologic outcome or neurocognitive function. METHODS: Between January 1999 and June 2001, 251 patients scheduled for coronary revascularization were divided into 2 groups, CABG (control) and OPCAB. All patients underwent an extensive neurologic and neurocognitive battery of tests preoperatively and postoperatively at 48 hours, 7 days, and 3 months following surgery. RESULTS: There were no statistically significant differences between the 2 groups regarding the preoperative or intraoperative data. The means for patient age, number of grafts, and number of central anastomoses were, respectively, 65.4 years (CABG) and 64.6 years (OPCAB), 3.0 (CABG) and 2.2 (OPCAB), and 2.0 (CABG) and 1.2 (OPCAB). The occurrence of stroke was 2.3% (CABG) and 0% (OPCAB). CONCLUSION: Neurologic complications and postoperative neurocognitive dysfunction remain major concerns in coronary artery surgery. Besides the occurrence of stroke, which dramatically reduces the success of the heart operation, the importance of neurocognitive disorders for postoperative quality of life is not yet well defined. OPCAB significantly improves postoperative neurocognitive function, which may in turn improve the postoperative quality of life.

Aged↗

PubMed1995

P300-mapping--a neurophysiological tool to quantify cerebral dysfunction after coronary artery bypass grafting.

Objective parameters are needed to quantify cerebral dysfunction following cardiac surgery in outcome and comparative studies. In this investigation we assessed the value of the late auditory evoked potentials N100 and P300 to measure the neuropsychological deficit after coronary artery bypass grafting (CABG). N100, an exogenous potential is influenced by the stimulus pattern (frequency, intensity and stimulus presentation rate). P300, an endogenous potential, depends on the cognitive processing invoked by the stimulus. With approval of the Human Investigation Committee and the patients' consents, 52 subjects undergoing elective CABG were enrolled. Operation, extracorporal circulation, anesthesia and postoperative intensive care were standardized. Twenty-channel recordings of N100 and P300 were obtained for off-line analysis. P300 was elicited using an oddball paradigm with rare target tones interspersed among frequent non-target tones. Additionally, neuropsychological tests (syndrome short test SKT and letter cancellation test) were carried out. Neurological examination and all tests were compared preoperatively and one week postoperatively. A significant deterioration in cerebral function was documented by the SKT score (P = 0.04), an increase in P300 latency (P = 0.004) and an increase of mistake rate in counting the P300 target tone (P = 0.02). No differences between preoperative and postoperative testing were found for letter cancellation, P300 amplitude and any N100 parameter. No correlation was found between the preoperative/postoperative changes in SKT score and P300 latency. P300 was proved to be an objective neurophysiological parameter that allows for the quantification of cerebral function after CABG.

Aged↗

PubMed2005

A syndromal analysis of neuropsychological outcome following coronary artery bypass graft surgery.

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.

Aged↗

PubMed1989

[Postoperative transitory syndrome and delirium].

In this review we discuss the symptoms, etiology and therapy of reversible organic mental disorders following surgery. Acute confusional states and delirium still pose difficult and unsolved problems in our operative wards and intensive care units. They are a major cause of morbidity and mortality following geriatric surgery. It is necessary to keep a watchful eye for signs of mild cerebral impairment. Slight disorientation, minor fear, depression or delusions can be the first step towards an aggressive or delirious restlessness. Changes in cognitive skills and a reduction in the operative level are useful guidelines. In most cases more than one etiological factor contributes to the psychopathology. The list of possible causes is long and the frequency and importance varies greatly. Preexisting dementia, unrecognized hypoxia, massive surgical procedures, extracorporeal circulation during cardiac surgery, drug and alcohol withdrawal, infections and the use of multiple medications with cerebral side effects can all interfere. A total, but reversible cerebral alteration or sometimes local damage with neurological dysfunction is thought to be part of the pathomechanism. Disorders of the blood-brain barrier, changes in transmitter turnover, disturbances in the circadian rhythm and REM sleep phases are also being considered. When attempting to make a diagnosis, one should look for signs of neurological damage, withdrawal reactions and exclude or verify major or menacing etiological factors. The therapeutic strategy consists of treatment of the underlying organic diseases, consistent and attentive care that provides orientation and support, and carefully selected medication. The change in pharmacokinetics during old age, and the anticholinergic or other confusion-inducing properties in drugs should be remembered. The administration of either minor or major tranquilizers should be in accordance with a clear treatment strategy.

Delirium↗

PubMed2003

Craniotomy for treatment of unruptured aneurysms is not associated with long-term cognitive dysfunction.

BACKGROUND AND PURPOSE: Many studies have reported frequent cognitive deficits associated with subarachnoid hemorrhage (SAH) and aneurysm repair. One study found more severe cognitive deficits after clipping than coiling of aneurysms, raising the possibility that deficits are due to surgery instead of SAH itself. This possibility was directly addressed by evaluating the cognitive effects of surgery without SAH. The goal of this study was to identify changes in cognitive function associated with surgical clipping of unruptured intracerebral aneurysms. METHODS: A consecutive series of 25 patients who underwent surgical clipping of >or=1 unruptured intracerebral aneurysm were tested within 1 week preoperatively and again postoperatively (before hospital discharge and at 3-month follow-up if they had deficits at discharge) on a neuropsychological battery. Different forms of each test were used preoperatively and postoperatively to reduce practice effects. Paired t tests were used to examine differences between preoperative and postoperative test scores across individuals. RESULTS: On most tests, there was no significant change between preoperative and postoperative scores. A significant decline in accuracy before hospital discharge was found only in figure copying (P<0.04) and associative learning (P<0.01), and significant slowing was found on 1 test (P<0.01). Even on these tests, only 3 of 25 patients showed significant deterioration. All but 1 patient returned to baseline by the 3-month follow-up. CONCLUSIONS: We found no evidence of subtle cognitive deficits resulting from aneurysm clipping alone, suggesting that the common impairments after surgery for ruptured aneurysms are due to SAH itself, complications of SAH such as vasospasm or hydrocephalus, or perioperative stroke.

Adult↗