title: Preliminary report of a genetic basis for cognitive decline after cardiac operations. The Neurologic Outcome Research Group of the Duke Heart Center.
abstract: BACKGROUND
  Changes in memory and cognition frequently follow cardiac operations. We hypothesized that patients with the apolipoprotein E-epsilon 4 allele are genetically predisposed to cognitive dysfunction after cardiac operations.
  
  
  METHODS
  The apolipoprotein E-epsilon 4 allele was evaluated as a predictor variable for postoperative cognitive dysfunction in 65 patients undergoing cardiac bypass grafting at Duke University Medical Center. The primary outcome measure was performance on a cognitive battery administered preoperatively and at 6 weeks postoperatively.
  
  
  RESULTS
  In a multivariable logistic regression analysis including apolipoprotein E-epsilon 4, preoperative score, age, and years of education, a significant association was found between apolipoprotein E-epsilon 4 and change in cognitive test score in measures of short-term memory at 6 weeks postoperatively. Patients with lower educational levels were more likely to show a decline in cognitive function associated with the apolipoprotein E-epsilon 4 allele.
  
  
  CONCLUSIONS
  This study suggests that apolipoprotein E genotype is related to cognitive dysfunction after cardiopulmonary bypass. Cardiac surgical patients may be susceptible to deterioration after physiologic stress as a result of impaired genetically determined neuronal mechanisms of maintenance and repair.
authors.affiliation: Department of Anesthesiology, Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: B E
authors.initials: BE
authors.lastname: Tardiff
authors.forename: M F
authors.initials: MF
authors.lastname: Newman
authors.forename: A M
authors.initials: AM
authors.lastname: Saunders
authors.forename: W J
authors.initials: WJ
authors.lastname: Strittmatter
authors.forename: J A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: W D
authors.initials: WD
authors.lastname: White
authors.forename: N D
authors.initials: ND
authors.lastname: Croughwell
authors.forename: R D
authors.initials: RD
authors.lastname: Davis
authors.forename: A D
authors.initials: AD
authors.lastname: Roses
authors.forename: J G
authors.initials: JG
authors.lastname: Reves
mesh_terms: D000367:Age Factors; D000483:Alleles; D001057:Apolipoproteins E / Q000235:genetics*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology* / Q000235:genetics; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006801:Humans; D016015:Logistic Models; D008297:Male; D008569:Memory Disorders / Q000209:etiology / Q000235:genetics; D008570:Memory, Short-Term; D008875:Middle Aged; D015999:Multivariate Analysis; D009416:Nerve Regeneration; D011597:Psychomotor Performance; D012307:Risk Factors; D013312:Stress, Physiological / Q000235:genetics; D016896:Treatment Outcome
chemical_list: D001057:Apolipoproteins E