Paper
Saturday, July 16, 2005
Neurocognitive Screening at Hospital Discharge: How Do Objective Results Compare to Patient Perception Three Months after Coronary Artery Bypass Graft Surgery (CABG)?
Kristin E. Sandau, RN, PhD1, Sue Sendelbach, RN, PhD, CCNS, FAHA1, Shigeaki Watanuki, RN, PhD2, Ruth Ann Lindquist, RN, PhD, APRN, BC, FAAN3, and Kay Savik, MS3. (1) Abbott Northwestern Hospital, Minneapolis, MN, USA, (2) School of Nursing and Rehabilitations, Aino University, Osaka, Japan, (3) School of Nursing, University of Minnesota, Minneapolis, MN, USA
Purpose: To compare objective neurocognitive function (cognitive and motor composite scores) preoperatively and before hospital discharge, with subjective neurocognitive symptoms (difficulty with concentration, memory, and word-finding), sleep satisfaction, and subjective mental health status (as measured by the Mental Component Score (MCS) of the SF-12) at 3-months post-CABG. Background/Significance: Studies examining objective neurocognitive functioning among CABG patients have increased over the past decade, while reports of subjective changes are seldom published and not often studied concurrently with objective testing. Methods: A convenience sample of elective 64 CABG patients ("on" and "off" pump, mean 62.5 years) at 2 Midwestern hospitals received objective neurocognitive testing preoperatively and before hospital discharge. Composite scores were calculated for cognitive and motor measures. At 3 months post-CABG patients completed the SF-12 and four investigator-developed questions asking participants to rate the frequency of neurocognitive symptoms and sleep difficulty from 1 (not at all) to 6 (everyday).Results: Preoperatively,the subjective symptoms of memory rho = -.29,p= .04)and word-finding difficulties (rho= -.30, p= .03) were correlated with motor composite scores, but only memory (rho= -.41, p=.002) was correlated with cognitive composite scores. No significant associations were found between objective function and concentration or sleep. Three months postoperatively, no significant correlations were noted between the objective scores measured at hospital discharge and the subjective neurocognitive symptoms or the SF-12. Conclusions: Patients reported less difficulty concentrating and remembering from pre- to 3-months post-CABG, consistent with improved cognitive composite scores. Although some significant values occurred, results do not support a strong correlation between objective and subjective neurocognitive scores or health status. Similar studies with larger sample sizes are needed to determine clinical relevance and effects on day-to-day functioning for any changes in objective neurocognitive scores. Continued measurement of quality of life should be concurrent with neurocognitive assessment to put clinicians' measurements alongside patients' perspectives.