title: Effects of dexamethasone on cognitive decline after cardiac surgery: a randomized clinical trial.
abstract: BACKGROUND
  Cardiac surgery can be complicated by postoperative cognitive decline (POCD), which is characterized by impaired memory function and intellectual ability. The systemic inflammatory response that is induced by major surgery and cardiopulmonary bypass may play an important role in the etiology of POCD. Prophylactic corticosteroids to attenuate the inflammatory response may therefore reduce the risk of POCD. The authors investigated the effect of intraoperative high-dose dexamethasone on the incidence of POCD at 1 month and 12 months after cardiac surgery.
  
  
  METHODS
  This multicenter, randomized, double-blind, placebo-controlled trial is a preplanned substudy of the DExamethasone for Cardiac Surgery trial. A total of 291 adult patients undergoing cardiac surgery with cardiopulmonary bypass were recruited in three hospitals and randomized to receive dexamethasone 1 mg/kg (n = 145) or placebo (n = 146). The main outcome measures were incidence of POCD at 1- and 12-month follow-up, defined as a decline in neuropsychological test performance beyond natural variability, as measured in a control group.
  
  
  RESULTS
  At 1-month follow-up, 19 of 140 patients in the dexamethasone group (13.6%) and 10 of 138 patients in the placebo group (7.2%) fulfilled the diagnostic criteria for POCD (relative risk, 1.87; 95% CI, 0.90 to 3.88; P = 0.09). At 12-month follow-up, 8 of 115 patients in the dexamethasone group (7.0%) and 4 of 114 patients (3.5%) in the placebo group had POCD (relative risk, 1.98; 95% CI, 0.61 to 6.40; P = 0.24).
  
  
  CONCLUSIONS
  Intraoperative high-dose dexamethasone did not reduce the risk of POCD after cardiac surgery.
authors.affiliation: From the Department of Anesthesiology (T.H.O., J.M.D., A.-M.C.S., C.J.K.), Department of Epidemiology, Julius Center for Epidemiology and Primary Care (L.M.P.), Department of Cardiothoracic Surgery (M.P.B.), and Intensive Care Medicine (D.v.D.), University Medical Center, Utrecht, The Netherlands; Department of Anesthesiology, Isala Clinics, Zwolle, The Netherlands (A.P.N.); Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands (W.J.d.G.); and Department of Cardiology, University Medical, Utrecht, The Netherlands (H.M.N.).
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Ottens
authors.forename: Jan M
authors.initials: JM
authors.lastname: Dieleman
authors.forename: Anne-Mette C
authors.initials: AM
authors.lastname: Sauër
authors.forename: Linda M
authors.initials: LM
authors.lastname: Peelen
authors.forename: Arno P
authors.initials: AP
authors.lastname: Nierich
authors.forename: Welmer J
authors.initials: WJ
authors.lastname: de Groot
authors.forename: Hendrik M
authors.initials: HM
authors.lastname: Nathoe
authors.forename: Marc P
authors.initials: MP
authors.lastname: Buijsrogge
authors.forename: Cor J
authors.initials: CJ
authors.lastname: Kalkman
authors.forename: Diederik
authors.initials: D
authors.lastname: van Dijk
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003072:Cognition Disorders / Q000517:prevention & control*; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone