In an article published online April 25, 2005, in the Annals of Neurology (www.interscience.wiley.com/journal/ana), the authors argue that the late cognitive declines seen in some long-term studies are likely associated with progression of underlying conditions such as cerebrovascular disease rather than the surgery itself.
"We think that there are short-term cognitive changes after CABG in a subset of patients, but absent a frank stroke, these changes are generally mild and transient," said author Ola Selnes, Ph.D., professor of neurology at Johns Hopkins Hospital in Baltimore, Maryland. "We believe most patients who experience cognitive decline will return to their baseline by three months or sooner."
The exceptions, according to Selnes, might include older patients and those with risk factors for cerebrovascular disease or a history of stroke.
In their review article, Selnes and co-author Guy M. McKhann, M.D., also of Johns Hopkins, surveyed the published studies on cognitive changes following CABG. Confusing the issue, they point out, is the variability in the way this question has been approached.
Selnes and McKhann note that the surgical procedure itself varies among different institutions and surgeons. Similarly, there is wide variance in study populations and control groups, follow-up periods, and statistical analysis.
It is curious, the authors note, that studies should continue to find cognitive deficits despite the fact that CABG is a procedure in evolution, with surgical and anesthesiological techniques improving vastly over the past decades. This may be due in part to the reality
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Contact: David Greenberg
dgreenbe@wiley.com
201-748-6484
John Wiley & Sons, Inc.
25-Apr-2005