• Helena Claesson Lingehall, Nina S Smulter, Elisabeth Lindahl, Marie Lindkvist, Karl Gunnar Engström, Yngve G Gustafson, and Birgitta Olofsson.
• 1Department of Nursing and Department of Surgical and Perioperative Science, Umeå University, Umeå, Sweden.2Department of Nursing, Umeå University, Umeå, Sweden.3Department of Public Health and Clinical Medicine, Epidemiology and Global Health and Department of Statistics, USBE, Umeå University, Umeå, Sweden.4Department of Surgical and Perioperative Science, Umeå University, Umeå, Sweden.5Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
• Crit. Care Med. 2017 Aug 1; 45 (8): 1295-1303.

ObjectiveTo investigate if postoperative delirium was associated with the development of dementia within 5 years after cardiac surgery.DesignLongitudinal cohort study.SettingCardiothoracic Division, Umeå University Hospital, Sweden.PatientsPatients aged 70 years old or older (n = 114) scheduled for routine cardiac procedures with cardiopulmonary bypass without documented dementia were enrolled in 2009.InterventionStructured assessments were performed preoperatively, 1 and 4 days after extubation, and 1, 3, and 5 years postoperatively.Measurements And Main ResultsPatients were assessed comprehensively, including cognitive and physical function, coexisting medical conditions, demographic characteristics, and medications. Diagnoses of delirium, depression, and dementia were made according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria. During the 5-year period, 30 of 114 participants (26.3%) developed dementia. Postoperative delirium had occurred in 87% of those who later developed dementia. A multivariable logistic regression model showed a lower preoperative Mini-Mental State Examination score (p < 0.001; odds ratio, 0.68; 95% CI, 0.54-0.84) and the occurrence of postoperative delirium (p = 0.002; odds ratio, 7.57; 95% CI, 2.15-26.65) were associated with dementia occurrence.ConclusionsOur findings suggest that older patients with reduced preoperative cognitive functions or who develop postoperative delirium are at risk of developing dementia within 5 years after cardiac surgery. Cognitive functions should be screened for preoperatively, those who develop postoperative delirium should be followed up to enable early detection of dementia symptoms, and management should be implemented.

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