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CARDIOVASCULAR ANESTHESIA

Preexisting Cognitive Impairment in Women Before Cardiac Surgery and Its Relationship with C-Reactive Protein Concentrations

Departments of Anesthesiology, Psychiatry, Neurology, Psychology, Radiology, and Biostatistics, Washington University School of Medicine, St. Louis, Missouri

Address correspondence to Charles W. Hogue, Jr., MD Department of Anesthesiology and Critical Care Med Johns Hopkins Hospital 600 N. Wolfe St, Tower 711 Baltimore, MD 21287–8711. Address e-mail to chogue2{at}jhmi.edu.

Preoperative cognitive state is seldom considered when investigating the effects of cardiac surgery on cognition. In this study we sought to determine the prevalence of cognitive impairment in women scheduled for cardiac surgery using nonhospitalized volunteers as a reference group and to examine the relationship between C-reactive protein levels and cognitive impairment. Psychometric testing was performed in 108 postmenopausal women scheduled for cardiac surgery and in 58 nonhospitalized control women. High sensitivity C-reactive protein levels were measured in the surgical patients. Preoperative cognitive impairment was defined as >2 sd lower scores on 2 tests compared with the controls. Cognitive impairment was present in 49 of 108 (45%) patients. C-reactive protein levels were higher for patients with compared with those without cognitive impairment (median, 8.1 mg/L versus 4.7 mg/L; P = 0.04). Based on multivariate logistic regression analysis, patient age, lower attained level of education, type 2 diabetes mellitus, and prior myocardial infarction identified risk for cognitive impairment (P < 0.05) but C-reactive protein levels did not (P = 0.09). In conclusion, cognitive impairment is prevalent in women before cardiac surgery. C-reactive protein levels are increased in women with this condition but the relationship between this inflammatory marker and preexisting cognitive impairment is likely secondary to the acute phase reactant serving as a marker for other predisposing conditions.

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