PREDICTORS OF COGNITIVE DECLINE AFTER CARDIAC OPERATION

Despite major advances in cardiopulmonary bypass technology, surgical techniques, and anesthesia management, central nervous system complica tions remain a common problem after cardiopulmonary bypass. The etiolo gy of neuropsychologic dysfunction after cardiopulmonary bypass remain s unresolved and is probably multifactorial. Demographic predictors of cognitive decline include age and years of education; perioperative f actors including number of cerebral emboli, temperature, mean arterial pressure, and jugular bulb oxygen saturation have varying predictive power. Recent data suggest a genetic predisposition for cognitive decl ine after cardiac surgery in patients possessing the apolipoprotein E epsilon-4 allele, known to be associated with late-onset and sporadic forms of Alzheimer's disease. Predicting patients at risk for cognitiv e decline allows the possibility of many important interventions. Pred ictive power and weapons to reduce cellular injury associated with neu rologic insults lend hope of a future ability to markedly decrease the impact of cardiopulmonary bypass on short-term and long-term neurolog ic, cognitive, and quality-of-life outcomes.