title: Cognitive function after heart transplantation: Comparing everolimus-based and calcineurin inhibitor-based regimens.
abstract: Studies have shown conflicting results concerning the occurrence of cognitive impairment after successful heart transplantation (HTx). Another unresolved issue is the possible differential impact of immunosuppressants on cognitive function. In this study, we describe cognitive function in a cohort of HTx recipients and subsequently compare cognitive function between subjects on either everolimus- or calcineurin inhibitor (CNI)-based immunosuppression.
  
  
  
  Cognitive function, covering attention, processing speed, executive functions, memory, and language functions, was assessed with a neuropsychological test battery. Thirty-seven subjects were included (everolimus group: n=20; CNI group: n=17). The extent of cerebrovascular pathology was assessed with magnetic resonance imaging.
  
  
  
  About 40% of subjects had cognitive impairment, defined as performance at least 1.5 standard deviations below normative mean in one or several cognitive domains. Cerebrovascular pathology was present in 33.3%. There were no statistically significant differences between treatment groups across cognitive domains.
  
  
  
  Given the high prevalence of cognitive impairment in the sample, plus the known negative impact of cognitive impairment on clinical outcome, our results indicate that cognitive assessment should be an integrated part of routine clinical follow-up after HTx. However, everolimus- and CNI-based immunosuppressive regimens did not show differential impacts on cognitive function.
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Department of Research and Education, Oslo University Hospital - Rikshospitalet, Oslo, Norway.|Department of Psychosomatic Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
authors.forename: Britta S
authors.identifier: 0000-0002-0544-5071
authors.initials: BS
authors.lastname: Bürker
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.affiliation: Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
authors.forename: Einar
authors.initials: E
authors.lastname: Gude
authors.affiliation: Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
authors.forename: Anne
authors.initials: A
authors.lastname: Relbo Authen
authors.affiliation: Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
authors.forename: Ingelin
authors.initials: I
authors.lastname: Grov
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
authors.forename: Per K
authors.initials: PK
authors.lastname: Hol
authors.affiliation: Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
authors.forename: Arne K
authors.initials: AK
authors.lastname: Andreassen
authors.affiliation: Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
authors.forename: Satish
authors.initials: S
authors.lastname: Arora
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Department of Cardiothoracic Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
authors.forename: Arnt E
authors.initials: AE
authors.lastname: Fiane
authors.affiliation: Department of Psychosomatic Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
authors.forename: Ira R
authors.initials: IR
authors.lastname: Haraldsen
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Department of Research and Education, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
authors.forename: Ulrik F
authors.initials: UF
authors.lastname: Malt
authors.affiliation: Department of Psychology, University of Oslo, Oslo, Norway.
authors.forename: Stein
authors.initials: S
authors.lastname: Andersson
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D000068338:Everolimus / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D006085:Graft Survival / Q000187:drug effects*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000068338:Everolimus
keywords: calcineurin inhibitors; cognition; cyclosporine; everolimus; heart transplantation; magnetic resonance imaging; tacrolimus