Preliminary report of a genetic basis for cognitive decline after cardiac operations. The Neurologic Outcome Research Group of the Duke Heart Center.
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.
Tardiff
B E
BE
Department of Anesthesiology, Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University Medical Center, Durham, North Carolina 27710, USA.
Newman
M F
MF
Saunders
A M
AM
Strittmatter
W J
WJ
Blumenthal
J A
JA
White
W D
WD
Croughwell
N D
ND
Davis
R D
RD
Roses
A D
AD
Reves
J G
JG
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
D001057:Apolipoproteins E