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Is There Evidence of Late Decline?

Ola A. Selnes, PhD; Richard M. Royall, PhD; Maura A. Grega, MSN; Louis M. Borowicz, Jr, MS; Shirley Quaskey, BS; Guy M. McKhann, MD

Arch Neurol. 2001;58:598-604.

Objective  To determine the long-term (preoperative to 5 years postoperative) and late (1-5 years postoperative) changes in cognitive test performance in patients after coronary artery bypass grafting.

Setting  The departments of surgery and neurology at The Johns Hopkins University School of Medicine, Baltimore, Md.

Patients  A group of 102 patients who completed preoperative and follow-up cognitive testing up to 5 years after coronary artery bypass grafting.

Main Outcome Measures  A battery of neuropsychological tests, assessing 8 cognitive domains (attention, language, verbal and visual memory, visuoconstruction, executive function, and psychomotor and motor speed), was administered preoperatively and at 1 month, 1 year, and 5 years postoperatively.

Results  Significant changes in neuropsychological test scores from baseline to 5 years were observed in only 3 of the 8 domains: there were declines in visuoconstruction and psychomotor speed and an improvement in executive function. When the period from baseline to 5 years was divided into 2 intervals, we found that cognitive test scores generally improved from baseline to 1 year. By contrast, between 1 and 5 years, there was significant decline in all cognitive domains except for attention and executive function. Some potential explanatory covariates (demographic, medical history, and surgery variables) were associated with changes from baseline to 5 years in some cognitive domains, but few covariates were statistically significant in more than 1 cognitive domain.

Conclusions  The change in cognitive test performance between baseline and 5 years is likely related to several factors, including low baseline performance and practice effects. The significant decline in performance between 1 and 5 years, however, raises the possibility that a late cognitive decline may be occurring in this population. Additional studies, with the use of a nonsurgical control group, are needed to determine if the observed cognitive decline is related to bypass surgery itself, normal aging in a population with cardiovascular risk factors, or some combination of these and other factors.

From the Departments of Neurology (Drs Selnes and McKhann, Mr Borowicz, and Ms Quaskey) and Surgery (Ms Grega), The Johns Hopkins University School of Medicine, Department of Biostatistics, The Johns Hopkins University, School of Public Health (Dr Royall), and the Zanvyl Krieger Mind/Brain Institute (Dr McKhann), Baltimore, Md.

Corresponding author and reprints: Ola A. Selnes, PhD, Division of Cognitive Neurology, Department of Neurology, Meyer 222, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287 (e-mail: Oselnes{at}jhmi.edu).

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