We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.
Intermediate- and long-term cognitive impairment may be uncommon after CV procedures among older adults, according to a systematic review published in the Annals of Internal Medicine.
Researchers analyzed data from 17 randomized controlled trials and four prospective cohort studies (mean age, 68 years; 80% men) that reported on cognitive outcomes at least 3 months after undergoing CABG, carotid revascularization or cardiac valve procedures among adults aged 65 years or older.
Howard A. Fink, MD, MPH, and colleagues found that in six studies comparing on- and off-pump CABG, three studies comparing hypothermic and normothermic CABG and one study comparing CABG with medical management, no significant differences between any of the groups were observed with regard to cognitive function.
In one study comparing minimal and conventional extracorporeal CABG, the minimal strategy was associated with reduced risk for incident cognitive impairment (risk ratio = 0.34; 95% CI, 0.16-0.73), according to the researchers.
Results from two trials comparing surgical carotid revascularization with carotid stenting or angioplasty indicated no difference in cognitive outcomes, Fink, from the Geriatric Research Education & Clinical Center, Veterans Affairs Health Care System, Minneapolis, and colleagues found.
In one cohort study, transcatheter aortic valve replacement was associated with increased cognitive decline compared with surgical AVR (28% vs. 6%; P = .041), but the researchers noted that the results may have been biased because patients in the TAVR group were older, less educated and had higher surgical risk. The study had other limitations, they wrote, including different definitions of cognitive decline and different batteries of tests administered. No significant within-group changes observed in any neuropsychological test were observed between baseline and 3 months.
In one cohort study comparing patients who underwent CABG alone with those who had surgical aortic or mitral valve replacement alone or combined with CABG, there were no differences between the groups in 6-month cognitive outcomes as indicated by 13 of 14 administered psychological tests, the researchers wrote.
Results from one trial comparing cognitive outcomes between hypothermic and normothermic surgical AVR indicated no between-group differences in cognitive outcomes at 4 months; however, no numerical data were provided, Fink and colleagues wrote.
In the 13 studies that reported incident stroke and transient ischemic attack, rates of stroke and TIA were low and there were no significant differences between groups in any study that reported stroke, TIA and cognitive outcomes, they wrote.
“Results suggest that persistent cognitive impairment after the studied [CV] procedures may be uncommon or reflect cognitive impairment that was present before the procedure,” Fink and colleagues wrote. “Physicians counseling older patients having the studied [CV] procedures should advise that although current data suggest cognitive risks may be small, there is substantial uncertainty about these estimates.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
We’re sorry, but an unexpected error has occurred.
Please refresh your browser and try again. If this error persists, please contact ITSupport@wyanokegroup.com for assistance.
Would you like to receive email reminders to complete your saved activities from Healio CME?
Activity saved! You'll receive reminders to complete your saved activities from Healio CME.