title: History of post-traumatic stress disorder is associated with impaired neuropsychometric performance after coronary artery surgery.
abstract: OBJECTIVE
  To determine if preoperative history of post-traumatic stress disorder (PTSD) is associated with postoperative cognitive impairment.
  
  
  METHODS
  An observational study.
  
  
  METHODS
  Veterans Affairs Medical Center.
  
  
  METHODS
  Cardiac surgical patients.
  
  
  METHODS
  None.
  
  
  RESULTS
  Age- and education-balanced patients (≥55 years of age) undergoing cardiac surgery (n = 30 with a history of PTSD+, n = 56 without a history of PTSD-) and nonsurgical controls (n = 28) were recruited. Recent verbal and nonverbal memory and executive functions were assessed before and 1 week after cardiac surgery or at 1-week intervals in nonsurgical controls. Demographic and medical parameters were similar between groups with the exception of preoperative depression and a history of alcohol dependence. Preoperative depression scores were significantly (p = 0.02) higher in PTSD+ compared with PTSD- groups. Immediate Word List Recall and Delayed Word List Recall under baseline conditions were worse in PTSD+ compared with PTSD- patients. Cognitive performance after surgery decreased by at least 1 standard deviation in 27 PTSD- patients (48%) and in 25 PTSD+ patients (83%) (p = 0.002) versus nonsurgical controls. Multivariate regression analysis (including a history of depression and alcohol dependence) revealed that a history of PTSD was significantly associated with overall (including nonverbal recent memory, verbal recent memory, and executive functions) postoperative cognitive dysfunction (p = 0.005).
  
  
  CONCLUSIONS
  The current findings suggest that patients with a history of PTSD undergoing coronary artery surgery using cardiopulmonary bypass may be especially vulnerable to postoperative cognitive impairment.
authors.affiliation: Department of Anesthesiology, Medical College of Wisconsin and Clement J Zablocki Veterans Administration Medical Center, Milwaukee, WI 53295, USA. judith.hudetz@va.gov
authors.forename: Judith A
authors.initials: JA
authors.lastname: Hudetz
authors.forename: Sweeta D
authors.initials: SD
authors.lastname: Gandhi
authors.forename: Zafar
authors.initials: Z
authors.lastname: Iqbal
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Patterson
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Byrne
authors.forename: David C
authors.initials: DC
authors.lastname: Warltier
authors.forename: Paul S
authors.initials: PS
authors.lastname: Pagel
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000150:complications; D001772:Blood Cell Count; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000523:psychology*; D002315:Cardiopulmonary Bypass / Q000523:psychology; D003072:Cognition Disorders / Q000523:psychology*; D003331:Coronary Vessels / Q000601:surgery*; D003863:Depression / Q000150:complications; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D011939:Mental Recall / Q000502:physiology; D008875:Middle Aged; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000523:psychology*; D011184:Postoperative Period; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000523:psychology; D014728:Veterans