Thursday, 7 January 2016

Memory Problems and Heart Disease: Postperfusion Syndrome and Vascular Dementia

Continuing on with a topic I ended 2015 on, Postperfusion “Pumphead” syndrome, memory loss and cognitive issues after open heart surgery.

I recently came across a blog on the internet called “Rehabilitate the Heart” which I felt is very relevant to those of us who have had open heart surgery and more importantly, an article that has relevance to those close to us including spouses, partners and children. 

And given this question of memory loss comes up so often in social media "heart" groups such as Facebook and in cardiac rehab programmes I feel another post on this topic is more than appropriate.

This blog not only continues on with the discussion regarding postperfusion syndrome but also introduces the question of Vascular Dementia.

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"Working in Cardiac Rehabilitation it wasn’t uncommon for a spouse or significant other to come in with the patient on the first day or early on in their rehabilitation and voice concern about the patients memory. It is common during the first three months after open heart surgery to be forgetful, to not remember little things, to be frustrated easily. However, within three months these issues should improve. There are a number of people however who have a steady decline in what we call cognitive health or  show cognitive impairment. They begin to display progress symptoms of dementia. This is very real and it is very scary, for both the patient and the caregiver.

Two common reasons for the mental decline are Pump Head and Vascular Dementia
Postperfusion syndrome, also known as “pumphead” is an impairment of cognitive symptoms attributed to Open Heart Surgery. Symptoms of postperfusion syndrome are subtle and include defects associated with attention, concentration, short term memory, fine motor function, and speed of mental and motor responses. Studies have shown a high incidence of these issues soon after surgery, but the deficits are often short lived with no permanent damage and last only a few months. It is when the symptoms persist beyond the first few months are concerning.

The symptoms of pumphead include:
·        difficulty in concentrating
·        increased depression
·        short term memory deficit
·        slower speed of mental and motor responses

“Pumphead”  refers to the state in which patients seem to linger after being hooked up to a heart-lung machine for open-heart or valve surgery.  The clinical term for pumphead is cognitive impairment after coronary artery bypass grafting (CABG). Other symptoms include poor recall, social difficulties and personality changes. Pumphead is when after an initial recovery of mental capabilities in the first few months, the condition often worsens later and persists for years.

Cognitive training may improve memory and reasoning in patients after CABG  

Thus the new area of rehabilitation, cognitive rehabilitation, such as after an acute injury to the brain like a closed head injury or a stroke.
"A new study results confirm that older adults who undergo CABG experience postoperative cognitive decline but show that cognitive training improves memory and attention, suggesting that this training can be a useful rehabilitation tool.
Cognitive training is a “burgeoning business,” much of which involves computer-based puzzles and brain games. While there’s a lot of suggestive evidence of an association between mental stimulation and lower risk for dementia, “we need to do more science around it to find out what works and what doesn’t work,”
http://www.theheart.org/article/1454099.do 





Is it Pump Head or Vascular Dementia?
Inadequate blood flow can damage and eventually kill cells anywhere in the body. The brain has one of the body’s richest networks of blood vessels and is especially vulnerable.
In vascular dementia, changes in thinking skills sometimes occur suddenly following strokes that block major brain blood vessels. Thinking problems also may begin as mild changes that worsen gradually as a result of multiple minor strokes or other conditions that affect smaller blood vessels, leading to cumulative damage. A growing number of experts prefer the term “vascular cognitive impairment (VCI)” to “vascular dementia” because they feel it better expresses the concept that vascular thinking changes can range from mild to severe.

Vascular brain changes often coexist with changes linked to other types of dementia, including Alzheimer’s disease."

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