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Cognitive and functional status predictors of delirium and delirium severity after coronary artery bypass graft surgery: an interim analysis of the Neuropsychiatric Outcomes After Heart Surgery study

Published online by Cambridge University Press:  01 October 2015

Mark A. Oldham Open the ORCID record for Mark A. Oldham [Opens in a new window] ,
Keith A. Hawkins ,
David D. Yuh ,
Michael L. Dewar ,
Umer M. Darr ,
Taras Lysyy  and
Hochang B. Lee
Mark A. Oldham*
Affiliation:
Psychological Medicine Section, Yale School of Medicine, New Haven, CT, USA
Keith A. Hawkins
Affiliation:
Psychological Medicine Section, Yale School of Medicine, New Haven, CT, USA
David D. Yuh
Affiliation:
Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
Michael L. Dewar
Affiliation:
Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
Umer M. Darr
Affiliation:
Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
Taras Lysyy
Affiliation:
Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
Hochang B. Lee
Affiliation:
Psychological Medicine Section, Yale School of Medicine, New Haven, CT, USA
*
Correspondence should be addressed to: Mark A. Oldham, Yale-New Haven Hospital, 20 York St., Fitkin 615, New Haven, CT 06510, USA. Phone: 203-785-2618. E-mail: [email protected].
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Abstract

Background:

Cognitive and functional impairment increase risk for post-coronary artery bypass graft (CABG) surgery delirium (PCD), but how much impairment is necessary to increase PCD risk remains unclear.

Methods:

The Neuropsychiatric Outcomes After Heart Surgery (NOAHS) study is a prospective, observational cohort study of participants undergoing elective CABG surgery. Pre-operative cognitive and functional status based on Clinical Dementia Rating (CDR) scale and neuropsychological battery are assessed. We defined mild cognitive impairment (MCI) based on either (1) CDR global score 0.5 (CDR-MCI) or (2) performance 1.5 SD below population means on any cognitive domain on neurocognitive battery (MCI-NC). Delirium was assessed daily post-operative day 2 through discharge using the confusion assessment method (CAM) and delirium index (DI). We investigate whether MCI – either definition – predicts delirium or delirium severity.

Results:

So far we have assessed 102 participants (mean age 65.1 ± 9; male: 75%) for PCD. Twenty six participants (25%) have MCI-CDR; 38 (62% of those completing neurocognitive testing) met MCI-NC criteria. Fourteen participants (14%) developed PCD. After adjusting for age, sex, comorbidity, and education, MCI-CDR, MMSE, and Lawton IADL score predicted PCD on logistic regression (OR: 5.6, 0.6, and 1.5, respectively); MCI-NC did not (OR [95% CI]: 11.8 [0.9, 151.4]). Using similarly adjusted linear regression, MCI-CDR, MCI-NC, CDR sum of boxes, MMSE, and Lawton IADL score predicted delirium severity (adjusted R2: 0.26, 0.13, 0.21, 0.18, and 0.32, respectively).

Conclusions:

MCI predicts post-operative delirium and delirium severity, but MCI definition alters these relationships. Cognitive and functional impairment independently predict post-operative delirium and delirium severity.

Keywords

deliriumneurocognitive impairmentfunctional statusneuropsychological testingCABG
Type
2015 IPA Junior Research Awards – First Prize Winner
Information
International Psychogeriatrics , Volume 27 , Issue 12 , December 2015 , pp. 1929 - 1938
Copyright
Copyright © International Psychogeriatric Association 2015 

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