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BJA Advance Access published online on April 2, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh157
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted February 1, 2004

Clinical Investigation

Detection of cognitive decline after coronary surgery: a comparison of computerized and conventional tests

B. S. Silbert 1*, P. Maruff 2, L. A. Evered 3, D. A. Scott 3, M. Kalpokas 3, K. J. Martin 3, M. S. Lewis 2, P. S. Myles 4

1 Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St Vincent’s Hospital, Melbourne, Australia; Department of Anaesthesia, St Vincent’s Hospital, Victoria Parade, Melbourne, Victoria 3065, Australia
2 Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St Vincent’s Hospital, Melbourne, Australia; School of Psychological Science, La Trobe University, Melbourne, Australia
3 Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St Vincent’s Hospital, Melbourne, Australia
4 Department of Anaesthesia and Pain Management, Alfred Hospital, Melbourne, Australia

* To whom correspondence should be addressed. E-mail: silberbs{at}svhm.org.au.


  Abstract

Background. Postoperative cognitive decline is a common complication after coronary artery bypass graft (CABG) surgery. Postoperative cognitive decline is defined on the basis of change in cognitive function detected with repeated assessments using neuropsychological tests. Therefore improvement in neuropsychological testing instruments may increase our understanding of postoperative cognitive decline.

Methods. Fifty patients undergoing CABG surgery completed both a conventional and a computerized battery of tests before and 6 days after CABG surgery. Fifty age- and education-matched controls completed the same test batteries 6 days apart. The reliability and the sensitivity to postoperative cognitive decline were computed for each battery.

Results. Both test batteries detected postoperative cognitive decline 6 days after CABG surgery. For the computerized battery, the reliability of the reaction times (intraclass correlation 0.89-0.92) was greater than for any test from the conventional battery (intraclass correlation 0.56-0.71), although accuracy measures were less reliable (intraclass correlation 0.61-0.89). The computerized battery detected all the cases of POCD identified by the conventional test battery and also five cases that were classified as normal by the conventional tests.

Conclusion. Computerized tests are suitable for measuring cognitive change after CABG surgery and may detect change in a greater proportion of patients 6 days after CABG surgery than conventional neuropsychological tests.

Keywords: Keywords: complications, cognitive deficit; monitoring, neuropsychological testing; surgery, cardiovascular


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