Preexisting cognitive status is associated with reduced behavioral functional capacity in patients 3 months after cardiac surgery: an extension study

Abstract

Objective: To examine whether preexisting cognitive status rather than short- and middle-term postoperative cognitive decline (POCD) may differentially account for behavioral functional capacity 3 months after cardiac surgery.

Method: Seventy-nine patients completed a psychological evaluation, including the Trail Making Test Part B, the memory with 10-s interference, the phonemic fluency and the Instrumental Activities of Daily Living (IADLs) questionnaire for cognitive functions and behavioral functional capacity, respectively, before surgery, at discharge and at 3-month follow-up.

Results: Thirty-one (39%) and 22 (28%) patients showed POCD at discharge and at 3-month follow-up, respectively. Preoperative cognitive status was significantly associated with change in behavioral functional capacity 3 months after surgery (Ps<.003), whereas short- and middle-term POCD and intraoperative risk factors were unrelated to residualized change in IADLs scores (all Ps>.095).

Conclusions: Preexisting cognitive deficit, especially working memory deficit, rather than short- and middle-term POCD related to intraoperative risk factors is associated with poor behavioral functional capacity 3 months after cardiac surgery. The present study therefore suggests that a preoperative cognitive evaluation is essential to anticipate which patients are likely to show a decline in behavioral functional capacity after cardiac surgery.

Keywords: Behavioral functional capacity; Cardiac surgery; Cognitive impairment; Cognitive–behavioral assessment; Neuropsychology.