title: Cognitive Outcomes of Cardiovascular Surgical Procedures in the Old: An Important but Neglected Area.
abstract: Older individuals can now undergo invasive cardiovascular procedures without serious concern about mortality, and the numbers and proportions of the over 65s and 85s doing so in Australia has been increasing over the last 20 years. There is overwhelming evidence linking cardiovascular conditions to late-life (65 years and over) cognitive impairment and dementia including Alzheimer's Disease, primarily due to impaired cerebrovascularisation and cascading neuropathological processes. Somewhat paradoxically, these cardiovascular interventions, carried out with the primary aim of revascularisation, are not usually associated with short- or long-term improvements in cognitive function in older adults. We discuss factors associated with cognitive outcomes post-cardiovascular surgeries in patients over 65 years of age. There are many opportunities for future research: we know almost nothing about cognitive outcomes following invasive cardiac procedures in the oldest old (85 years and over) nor how to predict the cognitive/delirium outcome using pre-surgical data, and lastly, intervention opportunities exist both pre and postoperatively that have not been tested. As our population ages with increased cardiovascular burden and rates of cardiovascular interventions and surgeries, it is critical that we understand the cognitive consequences of these procedures, who is at greatest risk, and ways to optimise cognition.
authors.affiliation: School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, SA, Australia. Electronic address: Hannah.Keage@unisa.edu.au.
authors.forename: Hannah A D
authors.initials: HA
authors.lastname: Keage
authors.affiliation: School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, SA, Australia; The Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, SA, Australia.
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Smith
authors.affiliation: School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, SA, Australia.
authors.forename: Tobias
authors.initials: T
authors.lastname: Loetscher
authors.affiliation: School of Medicine, University of Adelaide and Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Psaltis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000209:etiology / Q000503:physiopathology; D006348:Cardiac Surgical Procedures; D002318:Cardiovascular Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D003071:Cognition; D060825:Cognitive Dysfunction / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male
keywords: Cardiovascular surgery; Cognition; Dementia; Elderly; Old