Longitudinal Changes in Regional Cerebral Perfusion and Cognition Following Cardiac Surgery.
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Cardiac surgery has been associated with increased risk of postoperative cognitive decline, as well as dementia risk in the general population. Few studies, however, have examined the impact of coronary revascularization or valve replacement / repair surgery on longitudinal cerebral perfusion changes or their association with cognitive function.We examined longitudinal changes in cerebral perfusion among 54 individuals with cardiac disease; 27 undergoing cardiac surgery and 27 matched controls. Arterial spin labeling (ASL) magnetic resonance perfusion imaging was used to quantify cerebral blood flow within the anterior communicating artery (ACA), middle cerebral artery (MCA), and posterior communicating artery (PCA) vascular territories prior to surgery and postoperatively at 6-weeks and 1-year. Cognitive performance was examined during the same intervals using a battery of tests tapping memory, executive, information processing and upper extremity motor functions. Repeated measures, mixed models were used to examine for perfusion changes and the association between perfusion changes and cognition.Significant postoperative increases in perfusion were observed at 6-weeks within the MCA vascular territory following cardiac surgery (P = .035 for interaction). Perfusion changes were most notable in distal territories of the MCA and PCA at 6-weeks, with no additional changes at 1-year. Postoperative increases in MCA perfusion at 6-weeks were associated with improved psychomotor speed (β = 0.35, P = .016); whereas, no significant differences were found between groups in vascular territory perfusion and cognition at 1-year.Cardiac surgery is associated with significant short-term increases in MCA perfusion with associated improvements in psychomotor speed.
Published Version (Please cite this version)10.1016/j.athoracsur.2018.07.056
Publication InfoSmith, Patrick J; Browndyke, Jeffrey N; Monge, Zachary A; Harshbarger, Todd B; James, Michael L; Gaca, Jeffrey G; ... Neurologic Outcomes Research Group (NORG) (2018). Longitudinal Changes in Regional Cerebral Perfusion and Cognition Following Cardiac Surgery. The Annals of thoracic surgery. 10.1016/j.athoracsur.2018.07.056. Retrieved from https://hdl.handle.net/10161/17607.
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Professor of Medicine
John H. Alexander, MD, MHS is a cardiologist and Professor of Medicine in the Department of Medicine, Division of Cardiology at Duke University School of Medicine, as well as the Vice Chief, Clinical Research in the Division of Cardiology. He is the Director of Cardiovascular Research at the Duke Clinical Research Institute where he oversees a large group of clinical research faculty and a broad portfolio of cardiovascular clinical trials and observational clinical research programs. He is a
Associate Professor of Anesthesiology
My research team focuses on understanding the cause of postoperative cognitive dysfunction (POCD) and delirium, and whether these disorders are caused by perioperative changes in Alzheimer's disease pathways. We are also interested in whether delirium or POCD are associated with an increased long term risk of developing Alzheimer's disease. Towards these ends, we use a combination of methods including cognitive testing, CSF and blood sampling, functional neuroimaging, and rigorous biochemical as
Associate Professor of Psychiatry and Behavioral Sciences
Dr. Browndyke is an Associate Professor of Behavioral Health & Neurosciences in the Department of Psychiatry & Behavioral Sciences. He has a secondary appointment as Assistant Professor of Cardiovascular & Thoracic Surgery.Dr. Browndyke's research interests involve the use of advanced neurocognitive and neuroimaging techniques for perioperative contributions to delirium and later dementia risk, monitoring of late-life neuropathological disease progression, and inter
Associate Professor of Surgery
Medical Center Instructor in the Center for Brain Imaging and Analysis
Associate Professor of Anesthesiology
I have an extensive background in neuroanesthesia and neurointensive care and a special research interest in translational and clinical research aspects of intracerebral hemorrhage. After completing residencies in neurology and anesthesiology with fellowships in neurocritical care, neuroanesthesia, and vascular neurology, I developed a murine model of intracerebral hemorrhage in the Multidisciplinary Neuroprotection Laboratories at Duke University. After optimization of the model, I h
Jerry Reves, M.D. Distinguished Professor of Cardiac Anesthesiology
Current research interests include:1. The relationship between white matter patency, functional connectivity (fMRI) and neurocognitive function following cardiac surgery.2. The relationship between global and regional cortical beta-amyloid deposition and postoperative cognitive decline.3. The effect of lidocaine infusion upon neurocognitive function following cardiac surgery.4. The association between genotype and outcome after cardiac surgery.5. Atrial fibrillation
Professor of Surgery
Merel H. Harmel Distinguished Professor Emeritus of Anesthesiology
Best known for his work in assessing and improving clinical outcomes and quality of life following cardiac surgery, Dr. Mark Newman is President of the Duke Private Diagnostic Clinic (The Duke Faculty Practice Organization) and the Merel H. Harmel Professor of Anesthesiology at Duke University Medical Center. In addition, Dr. Newman developed the Multicenter Perioperative Outcomes Research Group of the Duke Clinical Research Institute established at Duke in 2001 to further the study of strategie
Associate Professor in Psychiatry and Behavioral Sciences
Dr. Smith is interested in the impact of lifestyle interventions, such as diet and exercise, on neurocognitive function and mood. He has also published multiple studies examining the relationship between cardiovascular disease, major depressive disorder, and neurocognitive outcomes, preoperative predictors of postoperative delirium, the impact of cardiothoracic interventions on neurocognitive outcomes, and the relationship between patterns of dietary intake and cardiovascular outcomes. He is als
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