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14 recordsLinked to original sources
PubMed2026

Impact of a multimodal prehabilitation program on postoperative cognitive dysfunction: a single-center randomized controlled trial.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a frequent complication after cardiac surgery. Exercise-based prehabilitation may enhance functional reserve and reduce vulnerability to perioperative cerebral insults. We hypothesized that multimodal prehabilitation reduces POCD 3&#xa0;months after cardiac surgery. METHODS: This prespecified substudy of a single-center randomized controlled trial (NCT03466606) included patients aged &#x2265;50&#xa0;years undergoing elective coronary artery bypass grafting and/or valve surgery. Participants were randomized 1:1 to 4-6&#xa0;weeks of multimodal prehabilitation (exercise training, nutritional support, and psychological support) or standard preoperative care. Cognitive function was assessed at baseline and 3&#xa0;months postoperatively using an age- and education-adjusted neuropsychological battery. POCD was defined as performance &#x2265;1.5 standard deviations below normative values in at least 2 cognitive tests, excluding the Mini-Mental State Examination. Logistic regression analyses were performed to evaluate factors associated with POCD. RESULTS: Of 160 participants screened from the parent trial, 134 met eligibility criteria for the substudy and were randomized; 116 completed 3-month follow-up (prehabilitation n&#xa0;=&#xa0;53; control n&#xa0;=&#xa0;63). POCD occurred in 29 patients (25%), including 15/53 (28%) in the prehabilitation group and 14/63 (22%) in controls (odds ratio [OR] 1.37, 95% confidence interval [CI] 0.54-3.50, P&#xa0;=&#xa0;0.52). In multivariable analysis, preoperative cognitive impairment was independently associated with POCD (OR 13.28, 95% CI 4.06-43.41, P&#xa0;<&#xa0;0.001), whereas prehabilitation was not (OR 1.09, 95% CI 0.35-3.45, P&#xa0;=&#xa0;0.877). Higher physical activity levels at 3&#xa0;months were associated with lower odds of POCD (OR 0.97, 95% CI 0.95-1.00, P&#xa0;=&#xa0;0.047). CONCLUSIONS: In this randomized controlled trial, a 4-6-week multimodal prehabilitation program did not reduce postoperative cognitive dysfunction 3&#xa0;months after cardiac surgery. Although the intervention did not achieve measurable cognitive protection, the observed association between postoperative physical activity levels and postoperative cognitive dysfunction warrants further investigation.

Humans↗
PubMed2026

Beyond motor: clinical manifestations of right hemisphere gliomas - a systematic review.

PURPOSE: Right-hemisphere gliomas have traditionally been regarded as less eloquent than left-sided lesions, influencing surgical decision-making and anesthetic approach. However, these tumors produce diverse non-motor manifestations affecting cognition, behavior, and socio-emotional functioning with important consequences for quality of life. This review aimed to characterize these manifestations and their implications for functional eloquence. METHODS: Following PRISMA guidelines, PubMed, Scopus, and Embase were searched using predefined terms for right-hemisphere gliomas and their manifestations. Eligible studies included patients with supratentorial right-hemisphere gliomas reporting motor and/or non-motor clinical manifestations. Studies were excluded if the clinical presentation was incompletely described or if glioma pathology lacked histopathological confirmation. Extracted data included tumor location, histopathology, clinical manifestations, neuropsychological assessments, and functional outcomes. RESULTS: A total of 372 patients from 88 studies were included. Median age was 42 years (range, 11-87), with slight male predominance (49% vs. 48% female). Preoperative non-motor manifestations were common and heterogeneous, most frequently compromising cognition and executive performance (43%), followed by vision and visuospatial deficits (28.4%) and language deficits (24%). Postoperatively, the most common deficits involved language (46%), followed by vision and visuospatial deficits (40%), and cognition and executive dysfunction (23.1%). Analyses relating extent of resection to postoperative deficits were considered exploratory because reporting of extent of resection and postoperative outcome assessment were incomplete and heterogeneous. CONCLUSIONS: Right-hemisphere gliomas carry a substantial and under-recognized burden of non-motor manifestations that challenge conventional definitions of functional eloquence and support the expansion of functional assessment and surgical planning encompassing right-hemisphere cognitive and behavioral networks.

Humans↗
PubMed1976

Analogical reasoning and postoperative outcome. Predictions for patients scheduled for open heart surgery.

We investigated whether postoperative outcome of open heart surgery is related to preoperative cognitive dysfunction. Patients ill enough to require open heart surgery frequently have gravely compromised circulation and, hence, possible brain damage. The Conceptual Level Analogy Test (CLAT), a new, rigorously constructed analogy test, was used to measure cognitive dysfunction. The results indicated that the CLAT, aministered preoperatively to open heart surgery patients, differentiated between patients having different types of postoperative outcome. A significant relationship between type of surgical procedure and poor postoperative outcome was also found; cardiac valvular surgery patients had significantly worse outcome than coronary bypass surgery patients. The incidence of good outcome (survival with no psychiatric complications) was 28% for cardiac valvular surgery patients with extremely poor preoperative CLAT scores, but 74% for valvular surgery patients with higher preoperative CLAT scores.

Cardiac Surgical Procedures↗
PubMed2026

AI-Supported, Integrative Prediction of Postoperative Delirium: Protocol for the CONFUSED Study.

BACKGROUND: Postoperative delirium (POD) is a frequent and serious complication in older surgical patients, characterized by acute cognitive dysfunction and fluctuating levels of consciousness. POD is associated with prolonged hospitalization, long-term cognitive decline, reduced quality of life, and increased mortality. Despite its clinical relevance, the underlying pathophysiological mechanisms remain poorly understood, and reliable biomarkers for early prediction and prevention are lacking. OBJECTIVE: The CONFUSED study aims to identify molecular and clinical predictors of POD by integrating clinical data with proteomic, transcriptomic, and epigenetic analyses. The primary objective is to develop predictive models for POD using multimodal data. Secondary objectives include the identification of delirium-associated genes, proteins, and epigenetic signatures, as well as the exploration of patient subgroups at increased risk for POD. METHODS: CONFUSED is a prospective observational cohort study conducted at a German university hospital. Adult patients undergoing major surgery under general anesthesia will be enrolled until 100 cases of POD have been observed, which is expected to require a total sample size of approximately 200 to 300 patients. Blood samples are collected at 4 predefined time points: before premedication, immediately after surgery, and on postoperative days 2 and 5. Samples undergo comprehensive proteomic profiling, transcriptomic analysis using RNA microarrays, DNA methylation analysis, and genotyping of selected polymorphisms. Clinical data, including demographics, comorbidities, perioperative variables, medications, and delirium assessments using the Confusion Assessment Method (CAM) and CAM for the intensive care unit, are systematically recorded. Statistical analyses include univariate and multivariate methods, as well as machine learning approaches such as random forests and support vector machines, to identify relevant biomarkers and develop predictive models. The study protocol follows STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) guidelines and was approved by the responsible ethics committees. RESULTS: The study was registered in the German Clinical Trials Register (DRKS00033854) on March 18, 2024. Recruitment started in January 2024 and is ongoing at the time of manuscript submission. As of now, 135 patients have been enrolled. Sample collection and laboratory analyses are ongoing. Data analysis began in January 2026, with first results anticipated in July 2026. Final data lock is anticipated after the completion of recruitment. CONCLUSIONS: By integrating multimodal molecular data with clinical parameters and applying advanced machine learning techniques, the CONFUSED study aims to improve the prediction and understanding of POD. The results are expected to support the development of personalized preventive strategies and contribute to improved perioperative care for patients at risk of POD.

Humans↗
PubMed1992

Patient memory before and after cardiac operations.

The memories of 20 patients undergoing elective operations on the heart were assessed by a comprehensive battery of standardized psychometric tests. Testing was conducted 1 to 2 days before, 7 to 10 days after, and 1 month after each operation. Twenty age-matched, healthy control subjects were given the same battery of tests at comparable times. Compared with healthy subjects, the patient group had significantly lower scores on 3 of 19 tests before, 10 of 19 tests 1 week after, and 5 of 19 tests 1 month after surgical intervention. The patient group had similar test performances before and 1 week after the operations and improved on 3 of 19 measures 1 month after the operations. Degrees of illness and cardiopulmonary bypass variables were significantly related to only a small subset of memory measures. Results of this study are consistent with previous reports that underscore the contribution of nonspecific aspects of surgical intervention to neuropsychologic dysfunction in the immediate postoperative period. We conclude that neither the illness nor the surgical variables are directly related to substantial variance in cognitive function after operations on the heart.

Adult↗
PubMed1975

Delayed hypoxic encephalopathy without cognitive dysfunction.

Three days after an episode of hypoxia, a 20-year-old man developed profound motor deficit in the absence of behavioral or cognitive disturbance. Previous reviews of delayed hypoxic encephalopathy have stressed behavioral and cognitive disturbances as the initial symptoms. This patient's pyramidal tract dysfunction in the absence of higher cortical dysfunction serves to illustrate that delayed hypoxic encephalopathy is predominantly a white matter rather than a gray matter disorder.

Adult↗
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↗
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↗
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↗
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↗
PubMed1991

Neuropsychological dysfunction after cardiopulmonary bypass: a comparison of two institutions.

The authors compared perioperative neuropsychologic dysfunction in patients participating in two studies conducted in institutions using different strategies to manage cardiopulmonary bypass. These differences included hypothermia versus normothermia, presence versus absence of arterial microfilters, and the presence versus absence of glucose-containing solution in the pump prime. Other differences between the two institutions included the type of surgery (intracardiac v extracardiac), the mean duration of cardiopulmonary bypass, and degree of low perfusion pressure during bypass. Despite these major differences, perioperative neuropsychologic dysfunction measured by the two-part Trail-Making psychometric test was similar in the two institutions. Several factors were analyzed for their possible contribution to development of dysfunction, including institution, anesthetic management, age, sex, degree of low perfusion pressure during bypass, and duration of bypass; only age was significant. These results suggest that differences in surgical procedure and management of cardiopulmonary bypass previously thought to contribute to the development of subtle cognitive deficits after cardiac surgery may have been overemphasized.

Adolescent↗
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↗
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↗