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Researchers isolate causes of cognitive loss following coronary artery bypass surgery
January 23, 2006Minimizing trauma to the body's largest artery - the aorta - during heart bypass surgery can significantly reduce cognitive loss that often follows the operation, a team from Wake Forest University School of Medicine reported today (Jan. 21) in the Journal of Thoracic and Cardiovascular Surgery.
"A surgical strategy designed to minimize aortic manipulations can significantly reduce the incidence of cognitive deficits in coronary artery bypass graft patients compared with traditional techniques," said the team, headed by John W. Hammon Jr., M.D., professor of cardiothoracic surgery.
Surgical technique is the primary cause of later thinking - cognitive - problems in coronary artery bypass graft patients, concluded the research team from the School of Medicine, part of Wake Forest University Baptist Medical Center. The team includes psychologists as well as surgeons, anesthesiologists and neuroradiologists.
Since the late 1980s, the team has focused on surgical technique. In 1997, they reported reducing stroke and other acute complications following coronary artery bypass surgery from the national average of six percent of patients to less than one percent of patients at Wake Forest University Baptist Medical Center, a national first.
Difficulty in thinking is also a widespread problem following bypass surgery, reported at many institutions. Since 1992, the Wake Forest research team has been investigating these cognitive complications following bypass surgery which normally employs the heart-lung machine. They developed methods to track the causes of the complications and test techniques to reduce the complications.
They have also been developing methods for doing coronary artery bypass without using the heart-lung machine. Much of the research over the years was paid for with a major grant from the National Institutes of Health.
In the new study of 237 patients, the team compared the standard method of coronary artery bypass using the heart-lung machine with surgical techniques that minimized movement of the aorta while still using the machine. Movement was reduced by using a single clamp that exerted significantly less force on the aorta than the standard cross clamp. Surgery without the machine was also compared.
The researchers gave the patients a battery of 11 psychological tests before surgery, then at three to five days after surgery, again between three and six weeks and again at six months. The tests measured such things as fine motor function, verbal and nonverbal memory, attention and concentration.
In the week after surgery, at least 60 percent of the patients in all three groups showed neurological deficits. The number of patients with deficits declined steadily in both the group without the heart-lung machine, and the group with minimal movement of the aorta. By six months, only 32 percent of the patients who didn't use the machine and 30 percent of the patients who had minimal aortic movement had deficits, suggesting less permanent injury in both groups.
But 57 percent of the patients who had the traditional surgery still had deficits at six months, the researchers reported. Based on monitoring techniques developed over the past 10 years at Wake Forest, the team tracked particles called emboli and gaseous bubbles going to the brain during the surgery. Team members believe the emboli are the cause of the neurological deficits.
Patients on whom the heart-lung machine was not used had significantly fewer emboli than patients who had the traditional operation - but that option is generally reserved for younger patients. Among patients who had the machine, those with minimal movement of the aorta had fewer emboli than those who had the traditional operation, but the difference did not reach statistical significance.
The research team notes that the results in the current study "confirm non-randomized data published from our institution in 1997."
Wake Forest University Baptist Medical Center
Since the late 1980s, the team has focused on surgical technique. In 1997, they reported reducing stroke and other acute complications following coronary artery bypass surgery from the national average of six percent of patients to less than one percent of patients at Wake Forest University Baptist Medical Center, a national first.
Difficulty in thinking is also a widespread problem following bypass surgery, reported at many institutions. Since 1992, the Wake Forest research team has been investigating these cognitive complications following bypass surgery which normally employs the heart-lung machine. They developed methods to track the causes of the complications and test techniques to reduce the complications.
They have also been developing methods for doing coronary artery bypass without using the heart-lung machine. Much of the research over the years was paid for with a major grant from the National Institutes of Health.
In the new study of 237 patients, the team compared the standard method of coronary artery bypass using the heart-lung machine with surgical techniques that minimized movement of the aorta while still using the machine. Movement was reduced by using a single clamp that exerted significantly less force on the aorta than the standard cross clamp. Surgery without the machine was also compared.
The researchers gave the patients a battery of 11 psychological tests before surgery, then at three to five days after surgery, again between three and six weeks and again at six months. The tests measured such things as fine motor function, verbal and nonverbal memory, attention and concentration.
In the week after surgery, at least 60 percent of the patients in all three groups showed neurological deficits. The number of patients with deficits declined steadily in both the group without the heart-lung machine, and the group with minimal movement of the aorta. By six months, only 32 percent of the patients who didn't use the machine and 30 percent of the patients who had minimal aortic movement had deficits, suggesting less permanent injury in both groups.
But 57 percent of the patients who had the traditional surgery still had deficits at six months, the researchers reported. Based on monitoring techniques developed over the past 10 years at Wake Forest, the team tracked particles called emboli and gaseous bubbles going to the brain during the surgery. Team members believe the emboli are the cause of the neurological deficits.
Patients on whom the heart-lung machine was not used had significantly fewer emboli than patients who had the traditional operation - but that option is generally reserved for younger patients. Among patients who had the machine, those with minimal movement of the aorta had fewer emboli than those who had the traditional operation, but the difference did not reach statistical significance.
The research team notes that the results in the current study "confirm non-randomized data published from our institution in 1997."
Wake Forest University Baptist Medical Center
Cognitive Loss Current Events and Cognitive Loss News RSSEstrogen therapy likely must be given soon after menopause to provide stroke protection
For estrogen replacement to provide stroke protection, it likely must be given soon after levels drop because of menopause or surgical removal of the ovaries, scientists report in the Journal of Neuroscience.
Moderate drinking can reduce risks of Alzheimer's dementia and cognitive decline
Moderate drinkers often have lower risks of Alzheimer's disease and other cognitive loss, according to researchers who reviewed 44 studies. In more than half of the studies, published since the 1990s, moderate drinkers of wine, beer and liquor had lower dementia risks than nondrinkers.
Calcium may be the key to understanding Alzheimer's disease
Researchers at the University of Pennsylvania School of Medicine have shown that mutations in two proteins associated with familial Alzheimer's disease disrupt the flow of calcium ions within neurons. The two proteins, called PS1 and PS2 (presenilin 1 and 2), interact with a calcium release channel in an intracellular cell compartment.
Ionophore reverses Alzheimer's within days in mouse models
Scientists report a remarkable improvement in Alzheimer's transgenic mice following treatment with a new drug. The study, published by Cell Press in the July 10th issue of the journal Neuron, provides the first demonstration that an ionophore, a compound that transports metal ions across cell membranes, can elicit rapid and pronounced improvement in neuropathology and cognitive function in mouse models of Alzheimer's Disease (AD).
Memory lane: Older persons with more schooling spend fewer years with cognitive loss
Those with at least a high school education spend more of their older years without cognitive loss - including the effects of Alzheimer's, Parkinson's and dementia -- but die sooner after the loss becomes apparent, reveals a new study appearing in the June 2008 issue of the Journal of Aging and Health.
Alzheimer's vaccine clears plaque but has little effect on learning and memory impairment
A promising vaccine being tested for Alzheimer's disease does what it is designed to do - clear beta-amyloid plaques from the brain - but it does not seem to help restore lost learning and memory abilities, according to a University of California, Irvine study.
Penn study finds inhaled anesthetics accelerate the appearance of brain plaque in animals
Researchers at the University of Pennsylvania's School of Medicine have discovered that common inhaled anesthetics increase the number of amyloid plaques in the brains of animals, which might accelerate the onset of neurodegenerative diseases like Alzheimer's.
Lower income means higher risk for heart disease
Low-income adults are more likely to have very high levels of C-reactive protein (CRP), a risk factor for heart disease.
Case School of Engineering professor applies virtual reality simulation to train world's brain and heart surgeons
Virtual reality simulation tools are already revolutionizing the way dentists are taught at Case Western Reserve University.
Weizmann Institute suggests that immune cells help to maintain cognition and brain cell renewal
A team of scientists at the Weizmann Institute of Science, led by Prof. Michal Schwartz of the Neurobiology Department, has come up with new findings that may have implications in delaying and slowing down cognitive deterioration in old age.
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