title: Measurement of post-operative cognitive dysfunction after cardiac surgery: a systematic review.
abstract: Post-operative cognitive dysfunction (POCD) is a decline in cognitive function from pre-operative levels, which has been frequently described after cardiac surgery. The purpose of this study was to examine the variability in the measurement and definitions for POCD using the framework of a 1995 Consensus Statement on measurement of POCD. Electronic medical literature databases were searched for the intersection of the search terms 'thoracic surgery' and 'cognition, dementia, and neuropsychological test.' Abstracts were reviewed independently by two reviewers. English articles with >50 participants published since 1995 that performed pre-operative and post-operative psychometric testing in patients undergoing cardiac surgery were reviewed. Data relevant to the measurement and definition of POCD were abstracted and compared with the recommendations of the Consensus Statement. Sixty-two studies of POCD in patients undergoing cardiac surgery were identified. Of these studies, the recommended neuropsychological tests were carried out in less than half of the studies. The cognitive domains measured most frequently were attention (n=56; 93%) and memory (n=57; 95%); motor skills were measured less frequently (n=36; 60%). Additionally, less than half of the studies examined anxiety and depression, performed neurological exam, or accounted for learning. Four definitions of POCD emerged: per cent decline (n=15), standard deviation decline (n=14), factor analysis (n=13), and analysis of performance on individual tests (n=12). There is marked variability in the measurement and definition of POCD. This heterogeneity may impede progress by reducing the ability to compare studies on the causes and treatment of POCD.
authors.affiliation: Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02130, USA. jrudolph@partners.org
authors.forename: J L
authors.initials: JL
authors.lastname: Rudolph
authors.forename: K A
authors.initials: KA
authors.lastname: Schreiber
authors.forename: D J
authors.initials: DJ
authors.lastname: Culley
authors.forename: R E
authors.initials: RE
authors.lastname: McGlinchey
authors.forename: G
authors.initials: G
authors.lastname: Crosby
authors.forename: S
authors.initials: S
authors.lastname: Levitsky
authors.forename: E R
authors.initials: ER
authors.lastname: Marcantonio
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000523:psychology*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D003245:Consensus Statements as Topic; D001026:Coronary Artery Bypass / Q000523:psychology; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D017410:Practice Guidelines as Topic; D012015:Reference Standards
references.citation: Ann Thorac Surg. 2008 May;85(5):1571-8
references.pmid: 18442540
references.citation: Ann Thorac Surg. 2004 Feb;77(2):597-603; discussion 603
references.pmid: 14759444
references.citation: J Thorac Cardiovasc Surg. 2001 Apr;121(4):743-9
references.pmid: 11279417
references.citation: Ann Thorac Surg. 2006 Jun;81(6):2105-14
references.pmid: 16731138
references.citation: Ann Thorac Surg. 1995 May;59(5):1289-95
references.pmid: 7733754
references.citation: J Cardiothorac Vasc Anesth. 2002 Feb;16(1):37-42
references.pmid: 11854876
references.citation: Ann Thorac Surg. 2002 Jun;73(6):2005-11
references.pmid: 12078822
references.citation: Ann Intern Med. 1990 Dec 15;113(12):941-8
references.pmid: 2240918
references.citation: J Neurol Sci. 2001 Jul 15;188(1-2):85-93
references.pmid: 11489290
references.citation: Ann Thorac Surg. 2007 Dec;84(6):1885-96
references.pmid: 18036903
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Heart. 2003 Aug;89(8):897-900
references.pmid: 12860868
references.citation: Ann Thorac Surg. 2004 Aug;78(2):513-8; discussion 518-9
references.pmid: 15276509
references.citation: Eur J Cardiothorac Surg. 1997 Mar;11(3):424-31
references.pmid: 9105803
references.citation: Stroke. 1998 Nov;29(11):2357-62
references.pmid: 9804648
references.citation: Ann Thorac Surg. 2009 Jan;87(1):36-44; discussion 44-5
references.pmid: 19101265
references.citation: Percept Mot Skills. 1968 Apr;26(2):643-50
references.pmid: 5659094
references.citation: J Thorac Cardiovasc Surg. 1996 Oct;112(4):1036-45
references.pmid: 8873731
references.citation: Anesth Analg. 2002 Jan;94(1):4-10, table of contents
references.pmid: 11772792
references.citation: J Cardiothorac Vasc Anesth. 2008 Aug;22(4):515-21
references.pmid: 18662624
references.citation: J Neurol Neurosurg Psychiatry. 1997 Jun;62(6):644-8
references.pmid: 9219757
references.citation: Eur J Cardiothorac Surg. 2008 Nov;34(5):1016-21
references.pmid: 18778948
references.citation: Anesthesiology. 2007 Mar;106(3):572-90
references.pmid: 17325517
references.citation: J Anesth. 2007;21(4):452-8
references.pmid: 18008111
references.citation: JAMA. 2007 Feb 21;297(7):701-8
references.pmid: 17312289
references.citation: Asian Cardiovasc Thorac Ann. 2009 Jun;17(3):259-65
references.pmid: 19643849
references.citation: Surg Today. 2006;36(12):1053-7
references.pmid: 17123132
references.citation: Eur J Cardiothorac Surg. 2006 Aug;30(2):294-9
references.pmid: 16829089
references.citation: Anesthesiology. 2006 Jun;104(6):1137-45
references.pmid: 16732083
references.citation: Ann Thorac Surg. 2005 Dec;80(6):2126-31
references.pmid: 16305857
references.citation: N Engl J Med. 2001 Feb 8;344(6):395-402
references.pmid: 11172175
references.citation: Stroke. 2009 Mar;40(3):880-7
references.pmid: 19164788
references.citation: Anesthesiology. 2002 Sep;97(3):585-91
references.pmid: 12218524
references.citation: Eur J Cardiothorac Surg. 2006 Jan;29(1):82-8
references.pmid: 16337395
references.citation: Stroke. 2007 Jul;38(7):2048-54
references.pmid: 17510454
references.citation: J Cardiothorac Vasc Anesth. 2001 Feb;15(1):9-14
references.pmid: 11254832
references.citation: Anesthesiology. 2001 Nov;95(5):1110-9
references.pmid: 11684979
references.citation: Mayo Clin Proc. 2002 Apr;77(4):384-92
references.pmid: 11936936
references.citation: Anesth Analg. 2002 Nov;95(5):1134-41, table of contents
references.pmid: 12401580
references.citation: Neurology. 2002 Sep 10;59(5):741-3
references.pmid: 12221167
references.citation: J Thorac Cardiovasc Surg. 1995 Nov;110(5):1302-11; discussion 1311-4
references.pmid: 7475182
references.citation: BMJ. 2006 Jun 10;332(7554):1365
references.pmid: 16740529
references.citation: J Thorac Cardiovasc Surg. 2007 Dec;134(6):1443-50; discussion 1451-2
references.pmid: 18023662
references.citation: J Thorac Cardiovasc Surg. 2006 Jan;131(1):114-21
references.pmid: 16399302
references.citation: J Neurol Neurosurg Psychiatry. 2005 Aug;76(8):1121-7
references.pmid: 16024891
references.citation: J Thorac Cardiovasc Surg. 1999 Mar;117(3):481-5
references.pmid: 10047650
references.citation: J Thorac Cardiovasc Surg. 2005 Nov;130(5):1319
references.pmid: 16256784
references.citation: Anesth Analg. 2000 Dec;91(6):1317-26
references.pmid: 11093972
references.citation: Anesth Analg. 2009 Oct;109(4):1013-22
references.pmid: 19762724
references.citation: J Thorac Cardiovasc Surg. 1995 Aug;110(2):340-8
references.pmid: 7637351
references.citation: Ann Neurol. 2008 May;63(5):581-90
references.pmid: 18481292
references.citation: Circulation. 2004 Nov 30;110(22):3411-7
references.pmid: 15557380
references.citation: Acta Anaesthesiol Scand. 2009 Aug;53(7):864-72
references.pmid: 19422355
references.citation: Semin Cardiothorac Vasc Anesth. 2005 Jun;9(2):119-21
references.pmid: 15920635
references.citation: Ann Thorac Surg. 2001 Dec;72(6):2026-32
references.pmid: 11789788
references.citation: J Cardiothorac Vasc Anesth. 2001 Feb;15(1):4-8
references.pmid: 11254831
references.citation: J Thorac Cardiovasc Surg. 2001 Jun;121(6):1150-60
references.pmid: 11385383
references.citation: J Card Surg. 2005 Sep-Oct;20(5):501-5
references.pmid: 16153291
references.citation: Ann Thorac Surg. 2007 Nov;84(5):1467-73
references.pmid: 17954047
references.citation: Ann Thorac Surg. 1995 May;59(5):1340-4
references.pmid: 7733765
references.citation: Heart Surg Forum. 2002;5(2):109-13
references.pmid: 12114123
references.citation: Br J Anaesth. 2001 Jan;86(1):63-7
references.pmid: 11575412
references.citation: N Engl J Med. 2009 Nov 5;361(19):1827-37
references.pmid: 19890125
references.citation: Circulation. 2007 Oct 23;116(17):1888-95
references.pmid: 17923575
references.citation: Clin Res Cardiol. 2007 Sep;96(9):600-3
references.pmid: 17593314
references.citation: Neurology. 1984 Jul;34(7):939-44
references.pmid: 6610841
references.citation: Ann Thorac Surg. 2006 Oct;82(4):1430-5
references.pmid: 16996947
references.citation: Stroke. 2004 Oct;35(10):2335-9
references.pmid: 15331798
references.citation: Neurology. 2005 Oct 11;65(7):991-9
references.pmid: 16107605
references.citation: J Thorac Cardiovasc Surg. 2000 Jan;119(1):148-54
references.pmid: 10612774
references.citation: J Thorac Cardiovasc Surg. 1996 Aug;112(2):514-22
references.pmid: 8751521
references.citation: Ann Thorac Surg. 2007 Dec;84(6):1897-903
references.pmid: 18036904
references.citation: Am J Crit Care. 2006 Sep;15(5):471-8; quiz 479
references.pmid: 16926368
references.citation: JAMA. 2002 Mar 20;287(11):1405-12
references.pmid: 11903027
references.citation: Health Psychol. 2003 Nov;22(6):579-86
references.pmid: 14640854
references.citation: Eur J Cardiothorac Surg. 2004 Feb;25(2):267-74
references.pmid: 14747125
references.citation: Ann Thorac Surg. 1995 May;59(5):1345-50
references.pmid: 7733766
references.citation: Circulation. 2006 Jun 20;113(24):2790-5
references.pmid: 16769915
references.citation: J Thorac Cardiovasc Surg. 1996 Jun;111(6):1267-79
references.pmid: 8642829
references.citation: Circulation. 2001 Sep 18;104(12 Suppl 1):I85-91
references.pmid: 11568036
references.citation: Ann Thorac Surg. 2003 Jul;76(1):18-25; discussion 25-6
references.pmid: 12842506
references.citation: Eur J Cardiothorac Surg. 1998 Jan;13(1):13-20
references.pmid: 9504725
references.citation: Ann Thorac Surg. 2009 Mar;87(3):820-5
references.pmid: 19231397
references.citation: Ann Thorac Surg. 1996 May;61(5):1342-7
references.pmid: 8633938
references.citation: Anaesthesia. 2008 Sep;63(9):941-7
references.pmid: 18547292
references.citation: J Thorac Cardiovasc Surg. 2007 May;133(5):1206-11
references.pmid: 17467430