• Monique T Fontes, R Cameron Swift, Barbara Phillips-Bute, Mihai V Podgoreanu, Mark Stafford-Smith, Mark F Newman, Joseph P Mathew, and Neurologic Outcome Research Group of the Duke Heart Center.
• Duke University Medical Center, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, P.O. Box 3094, Durham, NC 27710, USA.
• Anesth. Analg. 2013 Feb 1; 116 (2): 435442435-42.

BackgroundPostoperative neurocognitive decline occurs frequently. Although predictors of cognitive injury have been well examined, factors that modulate recovery have not. We sought to determine the predictors of cognitive recovery after initial injury following cardiac surgery.MethodsTwo hundred eighty-one patients previously enrolled in cognitive studies who experienced cognitive decline 6 weeks after cardiac surgery were retrospectively evaluated. Eligible patients completed a battery of neurocognitive measures and quality-of-life assessments at baseline, 6 weeks, and 1 year after surgery. Factor analysis was conducted to calculate the cognitive index (CI), a unified, continuous measure of cognitive function. Cognitive recovery was defined as 1-year CI greater than baseline CI. Potential predictors of cognitive recovery including patient characteristics, quality-of-life factors, comorbidities, medications, and intraoperative variables were assessed with multivariable regression modeling; P<0.05 was considered significant.ResultsOf the 229 patients in our final data set, 103 (45%) demonstrated cognitive recovery after initial decline in CI at 6 weeks. Multivariable analyses revealed that more education (odds ratio [OR] 1.332 [1.131-1.569], P<0.001), baseline CI (OR 0.987 [0.976-0.998], P=0.02), less decline in CI at 6 weeks (OR 1.044 [1.014-1.075], P=0.004), and greater activities of daily living at 6 weeks (OR 0.891 [0.810-0.981], P=0.02) were significant predictors of cognitive recovery.ConclusionCognitive recovery occurred in approximately one half of the cardiac surgical patients experiencing early decline. The association between cognitive recovery and Instrumental Activities of Daily Living scores at 6 weeks merits further investigation as it is the only potentially modifiable predictor of recovery.

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