Cognitive training after CABG helps protect mental function

Pauline Anderson

October 02, 2012

Montreal, QC - Cognitive training may improve memory and reasoning in patients after CABG, a new study suggests[1].

The results confirm that older adults who undergo CABG experience postoperative cognitive decline but show that cognitive training improves memory and attention, suggesting that this training can be a useful rehabilitation tool.

Dr Louis Bherer (Concordia University, Montreal, QC) wants his research to spur the inclusion of cognitive training into routine follow-up of patients undergoing CABG surgery. Just as patients routinely get physical training postsurgery, so too should they receive cognitive training, said Bherer. "It's virtually priceless, carries no risks, involves no pharmaceuticals, and patients can do it at home. It could be fun as well."

Bherer believes his study is the first to use cognitive training to improve cognition in older adults after CABG. "We knew that cognitive training leads to benefits in healthy older adults, that in some situations, you can improve memory and attention, but we wanted to find out if we could make an impact on those undergoing surgery," he said

The results, published in the October 2012 issue of the Journal of Behavioral Medicine, will be presented next month at the 2012 Congress of Physical Medicine and Rehabilitation in Toulouse, France.

Memory training

The analysis included 44 adults aged 65 and older who were scheduled for a first CABG surgery and had a Mini Mental State Examination (MMSE) score of at least 24. They were randomly assigned to one of three interventions: a control group (n=18), a group that received attention training that crossed over to memory training (n=13), or a group getting memory training that crossed over to attention training (n=13). Attention and episodic memory were targeted because these typically decline after CABG surgery, said Bherer.

All patients underwent a battery of neuropsychological tests the day before their surgery, three to 10 days after the surgery, and again one month following surgery. The one-month postsurgery assessment was used as a baseline prior to the intervention, which began between the sixth and eighth week after surgery.

Subjects received four training sessions of 50 minutes over two weeks and then were switched to the other intervention.

Researchers tested memory and attention at three and six months. Bherer stressed that these tests were different from those used for the training sessions. "These were tasks for which you were never trained, and so we can conclude that your memory is better and not just that you picked up very quickly how to do my task."

Performance improvement

The study showed that 65% of the patients showed a cognitive deficit one week after the surgery and 41% still showed deficit one month after surgery. However, those who received cognitive training showed significant improvement in performance compared with the control group.

For example, in an assessment of reaction time at six months, the mean time for a dual task in the control group was 2108 ms compared to 1836 ms for the attention-memory group and 1706 ms for the memory-attention group.

Subjects completing the attention task showed larger improvement in dual-task compared with single-task performance. This, said Bherer, suggests that dual-task training leads to enhanced divided attention and a better ability to coordinate the execution of multiple tasks.

"A great proportion of people improved after the memory and attention training, and that's important, because 60% to 70% of people will show cognitive decline after this surgery," said Bherer.

Most people experience some cognitive decline as they age, even if they don't show signs of mild cognitive impairment or dementia, said Bherer. Much of this may be due to a medical condition such as hypertension, diabetes, and heart disease. "One condition that provokes a lot of cognitive decline is coronary heart disease in general, and especially when a patient gets graft surgery."

Cardiovascular risk factors contribute to this decline, as could factors related to the surgery itself, such as anesthesia and intraoperative hypotension. Although there is some recovery after surgery, a significant decline persists—mostly in things like speed of processing, attention, and the ability to do multiple tasks. In some patients, and this could affect the quality of their daily living.

Systematic training

Asked for his views on the study, Dr Gary W Small (University of California, Los Angeles) said it "fits in with a lot of other studies showing that people with mild cognitive deficits can improve with systematic training."

He agreed that this training should be part of the rehabilitation process. "We've known for a number of years that people who undergo CABG have a higher risk of cognitive decline," he said. "So I think that just as we give people physical rehab, we ought to give them cognitive rehab following open heart surgery."

He noted that cognitive training is a "burgeoning business," much of which involves computer-based puzzles and brain games. While there's a lot of suggestive evidence of an association between mental stimulation and lower risk for dementia, "we need to do more science around it to find out what works and what doesn't work," said Small.

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