POCD HEART-BRAIN COMPLICATIONS: A NEUROPSYCHOLOGICAL AND PSYCHOLOGICAL OUTCOMES FOLLOWING CARDIO-SURGERY PRIN 2022 (cod. 2022PEK8YY)

Background. Postoperative Cognitive Dysfunction (POCD) affects approximately 50-67% of patients shortly after cardiac surgery. POCD is characterized by impairments in memory, executive functioning, attention, information processing, language, and perceptual-motor abilities (Vedel et al., 2019). Its etiology is multifactorial, involving cerebral emboli, hypoperfusion, and inflammation. Early detection through neuropsychological assessment is crucial but still under-researched (Glumac et al., 2021). The Enhanced Recovery After Surgery (ERAS) guidelines (Evered et al., 2018) recommend applying diagnostic tools used in neurocognitive disorder research to detect postoperative cognitive changes. Aims. This project aimed to design and implement a neuropsychological assessment for early POCD detection following cardiac surgery. Materials and methods. A neuropsychological protocol was developed and administered to 45 cardiac surgery patients (36 males, 9 females; mean age = 59.5; SD = 12; mean education = 17 years; SD = 5.6), recruited from IRCCS "San Raffaele" in Rome. Using SPSS software, we conducted descriptive statistics to profile cognitive performance and correlation analyses to identify connections with clinical data. Moreover, a Severity Index (SI) was created based on three factors commonly cited in the literature: number of heart bypasses, presence of hypertension, and time since surgery. Additional correlations examined links between psychological symptoms and neuropsychological outcomes. Results. Patients showed the worst performance in the Digit Span Forward (82.2% impaired) and Digit Span Backward (75.6%) tests. The SI did not correlate with any neuropsychological and emotional (DASS-21) score. However, performance on the Symbol Digit Modalities Test was significantly associated with hypertension (p = 0.033), and performance on the Clock Drawing Test was linked to valve type (p = 0.007). Rey’s Immediate Recall scores were negatively associated with DASS-21 depression scores (p = 0.022) and positively with SF-21 Mental Component Summary (MCS) score (p = 0.047). Semantic fluency was negatively correlated with DASS-21 depression scores (p = 0.036), DASS-21 anxiety score (p = 0.031), DASS-21 total score (p = 0.033), and positively with MCS score (p = 0.009). Discussion. Though preliminary, these results highlight a cognitive pattern of deficits in memory, attention and Executive Functions in postoperative cardiac patients. Findings suggest hypertension and valve replacement involving heart bypass may contribute to cognitive decline. Results confirm that hypertension is a risk factor for cognitive dysfunction. Conclusions. These results support the value of targeted neuropsychological screening as part of early POCD detection and recovery planning.