Nonpharmacological Cognitive Impairment Prevention Interventions in Older Adults Undergoing Cardiac Surgery: A Systematic Review.
Malissa A Mulkey, Asa B Smith, Rachel K Wion and 2 others
PMID 35953076WHAT IT FOUND
After cardiac surgery, no non-drug intervention consistently prevented overall thinking and memory decline.
Some small studies found benefits with cerebral oxygen monitoring or computerized cognitive training, but the evidence is too mixed to change routine care.
Key findings
01Across 19 included studies, overall global cognitive impairment after cardiac surgery did not improve, although some individual cognitive domains improved in separate studies.
02Remote ischemic limb preconditioning, the most common intervention, did not significantly improve postoperative delirium, postoperative cognitive dysfunction, dementia, global cognition, memory, attention, language, or executive function.
03Cerebral oxygenation monitoring reduced the incidence of postoperative cognitive impairment or delirium at 3 and 6 months in two studies, and computerized cognitive training improved several cognitive domains for up to one year.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The included studies used different definitions of cognitive impairment, different cognitive tests, and different assessment times. Most studies were single-site pilot studies with small samples, and few women were represented. Few studies assessed outcomes beyond 3 months, so long-term effects are unclear. Blinding, validated outcome measures, adequate power, and attrition reporting were often lacking. Valve-only patients were not studied separately, and one study used a non-surgical comparator. The review may have missed relevant articles because searches and title and abstract screening were limited.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not conclude that cerebral oxygen monitoring or computerized cognitive training is proven to prevent cognitive decline after cardiac surgery. The positive findings came from small, heterogeneous studies, and overall global cognitive impairment did not improve.