The impact of white matter lesions and subclinical cerebral ischemia on postoperative cognitive training outcomes after heart valve surgery: A randomized clinical trial

J Neurol Sci. 2024 Dec 26;469:123370. doi: 10.1016/j.jns.2024.123370. Online ahead of print.

ABSTRACT

BACKGROUND: White matter lesions and subclinical cerebral ischemia (SCI) are described as risk factors for postoperative cognitive decline (POCD) following cardiac surgery. This report aims to investigate the effect of brain lesions on postoperative cognitive training outcomes.

METHODS: In a randomized, treatment-as-usual controlled trial, elderly patients scheduled for elective heart valve surgery participated. The postoperative cognitive training comprised paper-and-pencil exercises. Neuropsychological parameters were assessed preoperatively, at discharge from rehabilitation (immediately post-training), and at the 3-month follow-up. In addition, depression and anxiety (HADS) as well as health-related quality of life (SF-36) were evaluated. Brain lesions were identified using magnetic resonance imaging (training group: n = 18; control group: n = 21). Specifically, periventricular white matter lesions (PVWML) and deep white matter lesions (DWML) were assessed using T2-weighted/FLAIR sequences and categorized according to Fazekas scale. Volumetric analysis of SCI was conducted using diffusion-weighted imaging. To statistically control the impact of brain lesions on training outcomes, we employed analysis of covariance.

RESULTS: Three-month follow-up results: When controlling for the independence of SCI on training outcomes, effects were evident for global cognition (p = 0.022) and SF-36 mental component summary (p = 0.003). Considering the impact of PVWML on training outcomes, trained participants showed better values in depression (p = 0.046) and SF-36 mental component summary (p = 0.013). In a subgroup analysis for patients with PVWML the training group demonstrated superior performance for language (p = 0.037). After adjusting for DWML, training effects were noticeable in the SF-36 mental component summary (p = 0.013).

CONCLUSION: Patients with brain lesions may benefit from cognitive training after cardiac surgery.

PMID:39764915 | DOI:10.1016/j.jns.2024.123370