• B E Tardiff, M F Newman, A M Saunders, W J Strittmatter, J A Blumenthal, W D White, N D Croughwell, R D Davis, A D Roses, and J G Reves.
• Department of Anesthesiology, Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University Medical Center, Durham, North Carolina 27710, USA.
• Ann. Thorac. Surg. 1997 Sep 1;64(3):715-20.

BackgroundChanges in memory and cognition frequently follow cardiac operations. We hypothesized that patients with the apolipoprotein E-epsilon 4 allele are genetically predisposed to cognitive dysfunction after cardiac operations.MethodsThe apolipoprotein E-epsilon 4 allele was evaluated as a predictor variable for postoperative cognitive dysfunction in 65 patients undergoing cardiac bypass grafting at Duke University Medical Center. The primary outcome measure was performance on a cognitive battery administered preoperatively and at 6 weeks postoperatively.ResultsIn a multivariable logistic regression analysis including apolipoprotein E-epsilon 4, preoperative score, age, and years of education, a significant association was found between apolipoprotein E-epsilon 4 and change in cognitive test score in measures of short-term memory at 6 weeks postoperatively. Patients with lower educational levels were more likely to show a decline in cognitive function associated with the apolipoprotein E-epsilon 4 allele.ConclusionsThis study suggests that apolipoprotein E genotype is related to cognitive dysfunction after cardiopulmonary bypass. Cardiac surgical patients may be susceptible to deterioration after physiologic stress as a result of impaired genetically determined neuronal mechanisms of maintenance and repair.

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