SEARCH · PubMed Health

Results for “Postoperative cognitive dysfunction”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 307 records · Page 17Linked to original sources

PubMed1999

Heart transplantation among 233 infants during the first six months of life: the Loma Linda experience. Loma Linda Pediatric Heart TransplantGroup.

Two hundred thirty-three heart transplantations were performed in infants during their first 6 months of life at Loma Linda University between November, 1985 and June, 1999. Survival has now exceeded 13 years. Nearly 70% of infants are expected to live at least 10 years. Those transplanted during the first 30 days of life have about a 15% survival advantage at 10 years. Scarcity of donors continues to limit the transplantation effort. While acute rejection is the most common cause of late mortality, posttransplant coronary artery disease (PTCAD) is the leading cause of graft loss affecting 22 recipients (9.5%). The majority of patients are asymptomatic prior to diagnosis of PTCAD and are either retransplanted or dead within 6 months. Retransplantation (9 of 11 retransplantations for PTCAD) has been highly successful, with 10 year actuarial survival of 91%. Posttransplant lymphoproliferative disease (PTLD) has been found in only 7 patients (3%), most commonly in lymph nodes. Causes of late mortality include acute rejection (n = 16), PTCAD (n = 9), infection (n = 7), PTLD (n = 2), chronic graft dysfunction (n = 2), arrhythmia (n = 1), recurrent pulmonary vein stenosis (n = 1), and other noncardiac causes (n = 4). Infant psychomotor development is mildly delayed although cognitive development is normal. School-age children are performing at the level of their peers with average achievement and low average intelligence testing. Heart transplantation is durable therapy for newborns and infants with structurally incurable and end-stage myopathic heart disease.

Brain Death↗

PubMed1998

Neurobehavioural disturbances, rehabilitation outcome, and lesion site in patients after rupture and repair of anterior communicating artery aneurysm.

OBJECTIVE: To determine: (1) patterns of cognitive and psychiatric dysfunction; (2) those neurobehavioural parameters which mostly influence disability in activities of daily living (ADL) and handicap in occupational and psychosocial activities, and (3) underlying neuroanatomical pathology in patients after rupture and repair of anterior communicating artery (ACoA) aneurysm. METHODS: 30 patients were extensively examined by means of a comprehensive battery of neuropsychological tests, by rating of psychopathological symptoms, and by use of the functional independence measure (FIM), Glasgow outcome scale (GOS), and MRI. RESULTS AND CONCLUSIONS: (1) Three main groups were characterised by primary impairment of memory, executive functions, or of attentional performance. Within these main groups, specific patterns were identified relating to extent of primary dysfunction and associated disorders. The variety of neuropsychological disturbances is in contradiction to the existence of an "ACoA syndrome" as an entity. (2) Rehabilitation outcome proved to be mostly associated with both memory and attentional performance. (3) In neuropathological terms, lesions of the medial septum and nucleus of the diagonal band of Broca (MS/ndbB) were closely associated with memory deficits and prefrontal lesions were associated with attentional, executive, and psychopathological dysfunctions. At the same time, bilateral lesions were associated with severe disturbances. The type and severity of the above mentioned deficits were independent of the side of lesion in unilateral cases, of rectus gyrus resection, and of the Hunt and Hess grading system.

Activities of Daily Living↗

PubMed1987

Neuropsychological deficits and real-world dysfunction in cerebral revascularization candidates.

An assessment strategy using multiple levels of observation permitted description of problems in everyday living experienced by cerebral revascularization candidates. We contrasted the neuropsychological deficits and real-world dysfunction displayed by candidates for cerebral revascularization with that manifested by patients with severe spinal complaints. Correlations between selected neuropsychological scores and life quality measures were modest. Prediction of real-world performance in individuals likely will require multivariate combinations of measures. Relationships between life quality measures and neuropsychological scores may differ for patients with known or suspected neurological disease and patients with disorders which do not threaten cognitive functioning.

Activities of Daily Living↗

PubMed1989

Late magnetic resonance imaging related to neurobehavioral functioning after aneurysmal subarachnoid hemorrhage.

Twenty patients who underwent early aneurysm surgery--that is, surgery within 72 hours after rupture--underwent further follow-up examination including magnetic resonance imaging (MRI) of the brain and a comprehensive neuropsychological assessment. Significant statistical correlation between tissue loss as seen on a late MRI scan and neurobehavioral deficits could not be established. Among 9 patients with no tissue loss seen on MRI, 3 exhibited substantial cognitive dysfunction and 6 had mild impairment. Three patients showed minor but corresponding tissue loss and deficits. In 3 patients with pronounced pathological indications on MRI, evidence of cognitive dysfunction was absent in 2, and 1 patient showed substantial impairment. The remaining 5 individuals displayed moderate pathological indications on MRI, with no obvious correspondence to cognitive functioning. In 7 patients, small white matter lesions, probably silent infarcts not seen on computed tomographic scan, were discovered on MRI. There was a clear relationship between arterial hypertension prior to aneurysm rupture and the extent of tissue loss seen on MRI. Absence of pathological findings on MRI scan did not exclude cognitive malfunctioning, and vice-versa.

Adult↗

PubMed1983

EEG monitoring in anesthesiology and intensive care.

Knowledge of the actual state of cerebral function and of the changes induced by psychotropic drugs is important not only to neurologically oriented specialties but also to other branches of medicine concerned with altering cerebral function. This applies especially to anesthesiology which involves numerous procedures leading to a temporary loss of cognitive brain function. Recently, the application of EEG combined with spectral analysis performed during anesthesia and intensive-care treatment has attracted attention: we investigated the changes in EEG during standardized anesthesiological and therapeutical procedures pre-, intra- and postoperatively, or during intensive-care treatment in 1,500 patients undergoing general surgery from 1977 to 1982. Two-track EEG leads accompanied by spectral analysis were used on line. The evaluation of routinely applied EEG monitoring justifies the following statements: EEG monitoring can be adapted technically and organized to comply with the working conditions and daily activities of an anesthesiological department. Spectral analytic representations allow the assessment of the EEG by the anesthesiologist. The various methods of general anesthesia produce specific EEG changes which can be obliterated by the cumulative effect of drugs. The actual depth of anesthesia is visible in the EEG. During a defined constant anesthetic depth, potentially hazardous cerebral dysfunctions can be detected early and treated accordingly. EEG monitoring can be useful in solving urgent medical problems of intensive-care therapy.

Anesthesia, General↗

PubMed2004

Preliminary report of the effects of complement suppression with pexelizumab on neurocognitive decline after coronary artery bypass graft surgery.

BACKGROUND AND PURPOSE: Pharmacological modulation of complement activation recently has been postulated as a therapeutic target in the treatment of neurological injury. We hypothesized that pexelizumab, a humanized scFv monoclonal antibody directed against the C5 complement component, would limit deficits in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass. METHODS: The Phase II Pexelizumab study was a 914-patient, double-blind, placebo-controlled, 65-center study of patients undergoing coronary artery bypass graft surgery. Patients were randomized to pexelizumab bolus, bolus plus infusion, or placebo. Neurological and neurocognitive functions were assessed as secondary endpoints at baseline and on postoperative days (POD) 4 and 30. Cognitive deficits were assessed with multivariable tests accounting for baseline cognition, age, diabetes, years of education, sex, elevated creatinine, history of myocardial infarction, neurological disorder or congestive heart failure, and cardiopulmonary bypass time. RESULTS: Pexelizumab had no statistically significant effect on the primary composite endpoint or on overall cognition. When domain specific effects were examined, a decline of at least 10% in the visuo-spatial domain was observed on POD 4 in 56% of patients receiving placebo compared with 40% receiving pexelizumab by bolus and infusion (P=0.003). Similarly, on POD 30, a 10% decline was present in 21% of patients in the placebo group versus only 12% of the drug bolus plus infusion group (P=0.016). No differences were seen between treatment groups in any of the other domains. CONCLUSIONS: Pexelizumab administration for 24 hours perioperatively had no effect on global measures of cognition but may reduce dysfunction in the visuo-spatial domain.

Aged↗

PubMed2006

Managing the cognitive effects of brain tumor radiation therapy.

Postoperative radiation therapy (RT), either alone or in combination with chemotherapy, is the mainstay of treatment for primary and/or metastatic brain tumors. The majority of patients with brain tumors will have significant symptoms of their disease and of RT that will have a negative impact on their quality of life and neurocognitive function. The symptoms of brain tumors depend on tumor location. Radiation-induced brain injury is a complex and dynamic process involving all cells in the brain, including endothelial and oligodendroglial cells, astrocytes, microglia, neurons, and neuronal stem cells. The symptoms of radiation-induced brain injury may be acute, subacute, or chronic, occurring hours, days, weeks, months, and even years after exposure to radiation, the pathogenesis of which is oxidative stress and inflammation. At present, there are no effective preventive approaches for radiation-induced brain injury. Rather, the management of radiation-induced fatigue, changes in mood, and cognitive dysfunction involves a multidisciplinary approach using pharmacologic, behavioral, and rehabilitative therapies. Given the prevalence of brain neoplasms and the high incidence of the radiation-induced symptom cluster and brain injury, clinical research to address these important clinical problems is critical.

Brain Neoplasms↗

PubMedDate not supplied

Thiopental sodium by single bolus dose compared to infusion for cerebral protection during cardiopulmonary bypass.

The authors previously demonstrated that thiopental sodium infused throughout cardiopulmonary bypass (CPB) considerably reduced persistent but not transient neuropsychiatric complications after open-chamber cardiac operations. Based on the probability that emboli released at the time of aortic declamping cause most postoperative central nervous system (CNS) dysfunction, this study was designed to test whether administration of a single bolus dose of thiopental before aortic declamping provided cerebral protection equal to that of infusion throughout bypass as well as a decrease in unwanted side effects. One hundred adult patients undergoing open-chamber cardiac operations with CPB received either thiopental sodium by infusion throughout CPB (n = 52) or thiopental sodium 15 mg/kg by bolus before aortic declamping (n = 48). In 90% of the patients, thiopental sodium 15 mg/kg produced electroencephalographic (EEG) burst suppression, with more than 60 seconds between bursts. Postoperative CNS dysfunction occurred in 3 (6%) of the infusion group patients (thiopental sodium 36 +/- 10 mg/kg) and 2 (4%) of the bolus group patients (thiopental sodium 16 +/- 2 mg/kg). CNS dysfunction persisting to the tenth postoperative day occurred in only one patient, who was in the infusion group. Requirements for inotropic support on separation from CPB did not differ between groups, but average time to extubation was 2.7 hours shorter in the bolus group. The authors conclude that thiopental sodium 15 mg/kg given as a single bolus immediately before aortic declamping without the need for EEG monitoring provided the same brain protection as larger doses given by infusion titrated to burst suppression, but it did not reduce the need for inotropic support during separation from CPB.

Adult↗

PubMed2006

Predictors of neurocognitive decline after carotid endarterectomy.

OBJECTIVE: Although the incidence of stroke after carotid endarterectomy (CEA) is low (1-3%), approximately 25% of patients experience subtle declines in postoperative neuropsychometric function. No studies have investigated the risk factors for this neurocognitive change. We sought to identify predictors of postoperative neurocognitive dysfunction. METHODS: We enrolled 186 CEA patients, with both symptomatic and asymptomatic stenosis, to undergo a battery of neuropsychometric tests preoperatively and on postoperative Days 1 and 30. Neurocognitive dysfunction was defined as a two standard deviation decline in performance compared with a similarly aged control group of lumbar laminectomy patients. Univariate logistic regression was performed for age, sex, obesity, smoking, symptomatology, diabetes mellitus, hypertension, hypercholesterolemia, use of statin medication, previous myocardial infarction, previous CEA, operative side, duration of surgery, duration of carotid cross-clamp, and weight-adjusted doses of midazolam and fentanyl. Variables achieving univariate P < 0.10 were included in a multivariate analysis. Data is presented as (odds ratio, 95% confidence interval, P-value). RESULTS: Eighteen and 9% of CEA patients were injured on postoperative Days 1 and 30, respectively. Advanced age predicted neurocognitive dysfunction on Days 1 and 30 (1.93 per decade, 1.15-3.25, 0.01; and 2.57 per decade, 1.01-6.51, 0.049, respectively). Additionally, diabetes independently predicted injury on Day 30 (4.26, 1.15-15.79, 0.03). CONCLUSIONS: Advanced age and diabetes predispose to neurocognitive dysfunction after CEA. These results are consistent with risk factors for neurocognitive dysfunction after coronary bypass and major stroke after CEA, supporting an underlying ischemic pathophysiology. Further work is necessary to determine the role these neurocognitive deficits may play in appropriately selecting patients for CEA.

Age Factors↗

PubMed1994

Impairment in shifting attention in autistic and cerebellar patients.

MRI and autopsy evidence of early maldevelopment of cerebellar vermis and hemispheres in autism raise the question of how cerebellar maldevelopment contributes to the cognitive and social deficits characteristic of autism. Compared with normal controls, autistic patients and patients with acquired cerebellar lesions were similarly impaired in a task requiring rapid and accurate shifts of attention between auditory and visual stimuli. Neurophysiologic and behavioral evidence rules out motor dysfunction as the cause of this deficit. These findings are consistent with the proposal that in autism cerebellar maldevelopment may contribute to an inability to execute rapid attention shifts, which in turn undermines social and cognitive development, and also with the proposal that the human cerebellum is involved in the coordination of rapid attention shifts in a fashion analogous to its role in the coordination of movement.

Adolescent↗

PubMed1999

Randomized trial of hypotensive epidural anesthesia in older adults.

BACKGROUND: Data are sparse on the incidence of postoperative cognitive, cardiac, and renal complications after deliberate hypotensive anesthesia in elderly patients. METHODS: This randomized, controlled clinical trial included 235 older adults with comorbid medical illnesses undergoing elective primary total hip replacement with epidural anesthesia. The patients were randomly assigned to one of two levels of intraoperative mean arterial blood pressure management: either to a markedly hypotensive mean arterial blood pressure range of 45-55 mmHg or to a less hypotensive range of 55-70 mmHg. Cognitive outcome was assessed by within-patient change on 10 neuropsychologic tests assessing memory, psychomotor, and language skills from before surgery to 1 week and 4 months after surgery. Prospective standardized surveillance was performed for cardiovascular and renal outcomes, delirium, thromboembolism, and blood loss and replacement. RESULTS: The two groups were similar at baseline in terms of age (mean, 72 yr), sex (50% women), comorbid conditions, and cognitive function. After operation, no significant differences in the incidence of early or long-term cognitive dysfunction were observed between the two blood pressure management groups. There were no significant differences in the rates of other adverse consequences, including cardiac, renal, and thromboembolic complications. In addition, no differences occurred in the duration of surgery, intraoperative estimated blood loss, or transfusion rates. CONCLUSIONS: Elderly patients can safely receive controlled hypotensive epidural anesthesia with this protocol. There was no evidence of greater risks, or early benefits, with the use of the more markedly hypotensive range.

Aged↗

PubMed1997

QEEG and neuropsychological profiles of patients prior to undergoing cardiopulmonary bypass surgical procedures.

Within our patient population undergoing cardiopulmonary bypass (CPB) surgery, evidence of pre-existing cortical dysfunction was highly prevalent, with 39.5% displaying QEEG and/or neuropsychological (NP) abnormality. These patients with pre-existing QEEG or NP abnormality were at increased risk for developing both short and long-term postoperative deficits in NP performance. Preoperative QEEG showed increased sensitivity and specificity over preoperative NP performance for predicting NP performance one week after surgery. One week after surgery NP deficits were quite common occurring in 40.6% of the patients. Two to three months after surgery evidence of continued NP performance deficits were still present in 28.1% of the patients. Preoperative NP performance predicted 3 month postoperative NP performance quite well, although preoperative QEEG proved equally effective.

Cardiac Surgical Procedures↗

PubMed1989

Assessment of desmopressin-enhanced cognitive function in a neurosurgical patient.

The vasopressin analog desmopressin (DDAVP) is known to enhance memory in animals and man but its precise mechanism of action is uncertain. We report the case of a patient who experienced chronic memory dysfunction with impaired job performance following transsphenoidal resection of a pituitary adenoma. A prospective double-blind, placebo-controlled trial of the effects of DDAVP was performed. Memory storage and recall improved with DDAVP treatment and declined within 1 week after drug withdrawal both by subjective and objective criteria. The Buschke Selective Reminding Test was clearly the most responsive out of a battery of standard memory testing paradigms employed to track the presence or absence of DDAVP treatment.

Adenoma↗

PubMed1996

The California Card Sorting Test may dissociate verbal and non-verbal concept formation abilities.

Most neuropsychological measures of executive function provide only global indices of performance and are relatively insensitive to lateralized dysfunction. The present paper presents a right temporal lobectomy patient whose performance indicates that the California Card Sorting Test, a new measure of executive function, may dissociate verbal and non-verbal concept formation abilities. This case highlights the potential research and clinical value of this test compared to that of existing tests of executive function.

Adult↗

PubMed1993

Psychoses in three cases with myasthenia gravis and thymoma--proposal of a paraneoplastic autoimmune neuropsychiatric syndrome.

Three patients with neuropsychiatric symptoms (NPSs) associated with thymoma, high serum titers of antiacetylcholine receptor (AchR) antibody and generalized myasthenia gravis (MG) are reported. The NPSs were homogeneous; (1) Altered consciousness as manifested by dreamy state with paramnesia, (2) psychosensory symptoms (the sudden change of senses of smell and taste with behavior abnormalities, auditory and visual hallucinations, déjà experiences, microteleopsia and derealization), (3) cognitive disturbances (recent memory loss with compulsive behaviors), (4) emotional disturbances (agitation, fear and anger), and (5) psychotic symptoms (secondary delusions and hallucinations) were characteristic. The NPSs preceded by several months to years the onset of MG, and thereafter they were closely related to worsening and relapse of MG. A typical patient showed repeatedly abnormal electroencephalograms (EEG) indicative of cerebral dysfunction. Another showed improvement of the NPSs after thymectomy and immunosuppressive therapy. The organicity of the phenomenology of psychoses with the same NPSs was suggested and it appears to comprise a unique paraneoplastic syndrome by central autoimmune mechanism. We proposed an autoimmune psychiatric syndrome and the genesis of psychosis due to the central cholinergic dysfunction in MG.

Adolescent↗

PubMed2000

Leukotomy revisited: late cognitive and behavioral effects in chronic institutionalized schizophrenics.

BACKGROUND: In the 1940s and 1950s, prefrontal lobotomy was widely used to treat aggressive, disruptive and psychotic behavior in schizophrenics. Subsequent observations have confirmed its ineffectiveness in schizophrenia. Few studies have addressed its long-term consequences. METHODS: We conducted tests of frontal function, behavior (Frontal Behavioral Inventory), psychopathology (PANSS), neurological examinations and CT scans in 19 chronically institutionalized schizophrenic patients (mean age 74) who had undergone orbitofrontal leukotomy between 1948 and 1972 and 11 controls (mean age 74) matched for age, length of hospitalization, education, and diagnosis. RESULTS: There were no significant differences between leukotomized patients and controls on: Folstein Mini-Mental score (leuko 22.13+/-5.66; controls 23.55+/-5.93), utilization behavior, Luria alternating written and motor sequences, verbal fluency, imitation behavior, motor impersistence, primitive reflexes, or psychopathology. Significant differences were found on clock drawing and on the go/no-go test, which may reflect the presence of an orbitofrontal lesion in the leukotomized group. There was a tendency for the leukotomized group to have fewer indices of frontal behavioral dysfunction. Both groups showed comparable impairment on the Stroop test and cognitive rigidity on the Odd Man Out test of category shifting. CONCLUSIONS: With few exceptions, elderly leukotomized and nonleukotomized schizophrenic patients show varying degrees of distractibility, difficulty in set shifting, poor planning and organization, susceptibility to interference, primitive reflexes and signs of global cognitive impairment. Allowing for the small sample size, variability in the surgical frontal lesion, and the long interval from surgery to testing, these observations likely reflect the long-term consequences of severe schizophrenia in both groups.

Aged↗

PubMed2004

Periventricular leukomalacia following neonatal and infant cardiac surgery.

The dramatic reduction in surgical mortality following repair of congenital heart defects has been accompanied by increasing recognition of adverse neurodevelopmental sequelae in some children. Neurodevelopmental abnormalities following neonatal and infant cardiac surgery include mild cognitive impairment, expressive speech and language abnormalities, impaired attention and executive function, impaired visual and spatial motor skills, as well as learning disabilities. These defects result in a significant need for early intervention, as well as rehabilitative and special education services. Central nervous system injury following repair of congenital heart defects results from a complex interaction of patient specific and environmental factors. Recent studies suggest that cerebral white matter injury characterized by periventricular leukomalacia (PVL) is common in infants with congenital heart disease particularly following cardiac surgery. Studies at our institution show that this occurs in greater than 50% of neonates following cardiac surgery, but is rare in older infants. Prolonged exposure to cardiopulmonary bypass (with or without deep hypothermic circulatory arrest) is a risk factor for PVL, possibly secondary to the systemic inflammatory response to cardiopulmonary bypass. Hypotension and hypoxemia in the early postoperative period, especially diastolic hypotension, significantly increase the risk of PVL. Future studies are needed to determine significance of PVL as a marker for long-term developmental dysfunction.

Cardiac Surgical Procedures↗

PubMed1995

Late post-operative hypoxaemia and organ dysfunction.

Constant and episodic hypoxaemia are common after major operations in the late post-operative period in the surgical ward. Recent studies have shown that hypoxaemia may be related to the development of myocardial ischaemia and cardiac arrhythmias. Experimental and clinical studies have demonstrated an adverse effect of tissue hypoxia on wound healing and on resistance to bacterial wound infections. Finally, mental confusion and surgical delirium may be related to inadequate arterial oxygenation during the late post-operative period. Late post-operative constant and episodic hypoxaemia may therefore be important surgical risk factors, and further studies on the pathogenesis, prophylaxis and treatment are warranted.

Arrhythmias, Cardiac↗