Prevention of Cognitive Frailty in Patients of Older Age Groups after Open-Heart Surgery under Cardiopulmonary Bypass

Abstract

Acute change in mental state is characterized by an impaired level of consciousness, decreased attention, and cognitive changes, and has a variable course throughout its period. Delirium is common in the elderly and hospitalized patients, especially after major surgeries, and increases mortality and morbidity in patients. This study was designed to investigate the relationship between the incidence of delirium after heart surgery and some intrusive factors during surgery. A total of 263 middle-aged, elderly, and chronic patients with functional class III-IV heart failure were classified based on the New York Heart Association classification and valvular heart disease. Cognitive impairment screening was performed using the Mini-Cog test and clock drawing test in addition to standard general clinical examinations on patients. Cognitive impairment was diagnosed in patients with coronary heart disease preparing for planned surgical treatment, regardless of age, while the results of both tests were significantly worse in elderly patients than in their middle-aged counterparts. In the early postoperative period, both among the middle-aged and elderly patients, there was a significant improvement in the results of the clock drawing test. Middle-aged patients also showed improved results on the Mini-Cog test, while the elderly patients showed an increase in cognitive dysfunction. In the third stage of the examination of cognitive function in the two studied groups of patients with valvular pathology at the first checkpoint, no statistically significant differences were found in the Mini-Mental State Examination (MMSE), Mini-Cog, and clock drawing test. The results of the clock drawing test in the main and control groups were recorded at 8.9±0.4 and 5.8±0.3 points, respectively (P<0.05). The MMSE results were estimated at the points of 27.1±0.1 and 24.1±0.2 in the main and control groups, respectively, while the results of the Mini-Cog test were calculated at 2.2±0.2 and 1.2±0.4 words in the main and control group, respectively (P<0.05). The application of the algorithm for the prevention of cognitive frailty in patients of older age groups after open-heart surgery under cardiopulmonary bypass would possibly lead to a decrease in the number of early and late postoperative complications, which shows the necessity of using it for patients of older age groups in multimodal programs to prepare them for surgical interventions.

Keywords

• cardiac surgeries
• cardiopulmonary bypass
• chronoblockers
• cognitive disorders
• metabolomics