Gender Differences in Neurocognitive Decline Among Cardiac Surgery Patients
Madigan Stanley1, Shawn Kant2, Neel Sodha1, Afshin Ehsan1, Frank Sellke1
1Division of Cardiothoracic Surgery, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, United States, 2Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
OBJECTIVE Evaluate differences in the incidence and severity of neurocognitive decline between female and male patients undergoing cardiac surgery.
DESIGN Prospective cohort study.
SETTING: Single academic center. Combination of ambulatory and hospitalized settings.
PATIENTS: 67 patients who were planned to undergo coronary artery bypass grafting (CABG), mitral valve replacement, or aortic valve replacement with the use of cardiopulmonary bypass were enrolled. Patients were referred by members of their care team at either the preoperative appointment or while hospitalized with planned cardiac surgery during that admission. 58 patients (19 women and 39 men) underwent surgery and completed both pre-operative and post-operative neurocognitive testing. One patient withdrew, two were lost to follow-up, and five were unable to complete post-operative testing due to medical condition.
MAIN OUTCOME MEASURES: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was administered preoperatively and on post-operative day four. The test is designed with multiple variations to minimize test/retest and familiarity effects. Neurocognitive decline is defined as a decrease in the RBANS total scaled score from pre- to post-operative tests.
RESULTS: 37 patients developed neurocognitive decline for an overall incidence of 64%. A chi-square test of independence showed no significant relationship between gender and incidence of neurocognitive decline, X2 (1, N=58) = 1.20, p = .27. However among the 37 patients who had neurocognitive decline, women (M = -13.8, SD = 6.5) had a significantly greater decrease in score, t(35) = 2.0, p = 0.04, than the men (M = -8.9, SD = 7.6). Analysis of the subtests also demonstrated that women had a significantly larger decrease in score compared to men in 2 of 8 subtests: Figure Copy (M = -3.7 vs -0.8 respectively, t(56) = 2.0, p = .02) and Semantic Fluency (M = -2.5 vs 0.6 respectively, t(56) = 2.0, p = <.01. The average age was similar for women (M = 69, SD = 6.7) and men (M = 68, SD = 8.6), t(56) = 2.0, p = 0.65. Pre-operative hematocrit was different between women (M = 38) and men (M = 42).
CONCLUSIONS: Among patients who experienced neurocognitive decline, the degree of negative score change was significantly greater for women than men. This suggests that when women experience neurocognitive decline after surgery it may be to a greater degree. Future research will focus on assessing the impact of this difference on clinical outcomes and quality of life, along with identifying potential differences in genomic and biochemical expression levels between men and women that may contribute to these findings. Lower pre-operative hematocrit has previously been associated with increased risk of neurocognitive decline which may partially explain the gender difference.
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