POCD Heart-Brain complications: a neuropsychological and psychological assessment of cognitive deficits following Cardio-surgery PRIN 2022 (2022PEK8YY)

Introduction: Postoperative Cognitive Dysfunction (POCD) occurs in 50–67% of patients shortly after cardiac surgery, involving deficits in memory, attention, executive functioning, language, and perceptual-motor abilities. The etiology is multifactorial—cerebral emboli, hypoperfusion, and inflammation being major contributors. Despite recommendations from Enhanced Recovery After Surgery (ERAS) guidelines to use neurocognitive diagnostic tools, early detection through neuropsychological assessment remains underused. Methods: This study aimed to design and apply a neuropsychological protocol for early POCD detection. Forty-five cardiac surgery patients (36 males, 9 females; mean age = 59.5 years; mean education = 17 years) were assessed at IRCCS “San Raffaele” in Rome. Descriptive statistics were used to evaluate cognitive performance, and correlation analyses were conducted using SPSS. A Severity Index (SI) was developed based on three clinical factors: number of bypasses, presence of hypertension, and time since surgery. Additional analyses examined associations between psychological symptoms (DASS-21) and neuropsychological performance. Results: The most impaired performances were in Digit Span Forward (82.2%) and Backward (75.6%). The SI did not correlate with cognitive or emotional scores. However, performance on the Symbol Digit Modalities Test was significantly associated with hypertension (p = 0.033), and Clock Drawing Test performance with valve type (p = 0.007). Rey’s Immediate Recall was negatively associated with DASS-21 depression (p = 0.022) and positively with SF-21 MCS scores (p = 0.047). Semantic fluency correlated negatively with DASS-21 depression, anxiety, and total scores, and positively with MCS (p = 0.009). Conclusions: Preliminary results suggest early cognitive deficits in memory and executive functions after cardiac surgery. Hypertension and valve surgery may be contributing factors. Early neuropsychological screening appears useful for identifying POCD and supporting recovery planning.