COGNITIVE AND EMOTIONAL VULNERABILITY PROFILES AND RECOVERY TRAJECTORIES AFTER CARDIAC SURGERY PRIN 2022 (2022PEK8YY)

INTRODUCTION. Perioperative neurocognitive disorders (PND) encompass a range of cognitive alterations occurring in the perioperative period (1). After cardiac surgery, cognitive and psychological outcomes show substantial inter-individual variability, with patients exhibiting different patterns of vulnerability and recovery. This variability may partly reflect differences in patients’ cognitive and emotional profiles at the early postoperative stage (1,2). This study aimed to identify homogeneous patterns of cognitive and emotional profiles among patients following cardiac surgery. METHODS. A standard neuropsychological protocol typically used for the assessment of behavioural and cognitive performance in neurological patients was adapted. A psychological evaluation was carried out (DASS-21, ERQ and SF-12). Cognitive and emotional measures at baseline were standardized and entered a hierarchical cluster analysis followed by K-means clustering. Mixed models were then used to compare the two vulnerability profiles across different cognitive domains by longitudinally evaluating patient performance at T1, T2, and T3. RESULTS. Two distinct cognitive and emotional vulnerability profiles were identified. The lower-vulnerability profile showed better cognitive performance and lower emotional distress, whereas the higher-vulnerability profile showed lower cognitive performance and greater emotional distress. The two clusters showed different recovery trajectories in executive-visuospatial functioning (time × cluster, p=.010), verbal fluency (p=.006), working memory (p=.002), and verbal episodic memory (p=.002), whereas processing speed/attention did not show a significant difference (p=.457). The higher- vulnerability group showed greater changes across several cognitive domains. DISCUSSION. Postoperative cognitive recovery after cardiac surgery is heterogeneous and domain specific. Patients with different levels of cognitive and emotional vulnerability at the early postoperative assessment showed different recovery trajectories across cognitive domains. Importantly, the magnitude of improvement should be interpreted in relation to patients’ starting level: greater cognitive improvement does not necessarily correspond to better overall recovery. Identifying postoperative vulnerability profiles may help characterize individual recovery trajectories and could contribute to more personalized postoperative cognitive care.