Cardiac Surgery and Cognition: Etiologies and Assessment Considerations

Abstract

Over half a century of research substantiate that some individuals are at increased risk for perioperative neurological injury and postoperative cognitive dysfunction (POCD) following cardiac surgery. Perioperative neurovascular damage associated with cardiosurgical intervention ranges from overt stroke to covert embolic injury, while other perioperative complications confer additive or additional risks (e.g., hypoperfusion, neuroinflammation, etc.). While cardiosurgical procedures (both simple and complex) carry inherent risks for a myriad of potential neurological and systemic complications, the full panoply of causal mechanisms and their interaction producing POCD remain elusive. Noncardiac surgery has been associated with similar patterns of POCD, but several lines of research demonstrate that both early and late onset rates of POCD are considerably higher among those who underwent cardiac compared to noncardiac surgery. While cardiac surgery is associated with higher rates of POCD and neurological complications, the presence of POCD in noncardiac surgical interventions suggests that there are shared general surgical factors contributing to POCD onset and severity.