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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Use this link to read the entire blog: https://rehabilitateyourheart.wordpress.com/2012/10/08/memory-problems-with-heart-disease-pump-head-and-vascular-dementia/

Pump Head - Cognitive Impairment After Bypass Surgery

A study from Duke University, published in the New England Journal of Medicine in February, 2001, confirms what many doctors have suspected, but have been reluctant to discuss with their patients: A substantial proportion of patients after coronary artery bypass surgery experience measurable impairment in their mental capabilities.

In the surgeons’ locker room, this phenomenon (not publicized for obvious reasons) has been referred to as "pump head."

In the Duke study, 261 patients having bypass surgery were tested for their cognitive capacity (i.e. mental ability) at four different times: before surgery, six weeks, six months, and five years after bypass surgery.

Patients were deemed to have significant impairment if they had a 20% decrease in test scores.

This study had three major findings

·        * Cognitive impairment does indeed occur after bypass surgery. This study should move the existence of this phenomenon from the realm of locker room speculation to the realm of fact.

·        * The incidence of cognitive impairment was greater than most doctors would have predicted. In this study, 42% of patients had at least a 20% drop in test scores after surgery.

·        * The impairment was not temporary, as many doctors have claimed (or at least hoped).

You can read more about this study using this link: http://heartdisease.about.com/cs/bypasssurgery/a/pumphead.htm

Postperfusion syndrome, also known as "pumphead"

"Postperfusion syndrome, also known as "pumphead", is a constellation of neurocognitive impairments attributed to cardiopulmonary bypass during cardiac 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 neurocognitive deficit soon after surgery, but the deficits are often transient with no permanent neurological impairment." http://en.wikipedia.org/wiki/Postperfusion_syndrome

This is not something to be dismissed lightly and many who have had bypass surgery comment on issues such as memory loss after surgery. Sometimes talking to others who have dealt with this problem is helpful.

Postperfusion Syndrome (pumphead) Facebook groups:

These groups may help people who have suffered memory loss after cardiac surgery and/or issues with fine motor skills and speed of mental and motor responses. Use these links to find out more about these group:

https://www.facebook.com/groups/277112179141875/
https://www.facebook.com/groups/1490829674283544/

Second Cardiac Rehab Talk for 2015

On Thursday, I gave my second talk for the year to our local cardiac rehab unit with 23 people in attendance. Whilst setting up before the presentation a lady came over smiling and to say hello and introduce herself and remind me she was the person who co-ordinated a talk I gave for Heart Foundation to her local Probus group in July, 2012.

I told her I most definitely remembered that talk where she introduced me to the crowd of over 80 people who attended that day and I told her, to this day, it was one of my most satisfying talks. Apparently her husband had a bad asthma attack in December, not a heart attack, when they discovered he had some severe blockages that required a triple bypass hence here being there today with her husband. It was good to see both of them today and to see how well her husband is doing on his road to recovery.

As usually happens, people came up to me afterwards to ask questions and one was from the wife of someone who also had bypass surgery and was having issues with concentration, reading and memory. We talked a bit about this and I mentioned something called Postperfusion syndrome (also known as Pumphead) which is not unusual for someone who has had bypass surgery. She was worried, and rightly so, that it was something out of the norm and I tried to reassure her it is not unusual and it might be a good idea for both of them to have a chat with their GP or cardiologist where she could get a better explanation. I told her I am not a doctor and am not qualified to talk more about this condition but suggested she could also bring this up with one of the wonderful staff at cardiac rehab.

Another person who himself has previously had heart issues was there today with his wife who is now dealing with the after effects of a heart event and who is in denial and has a bit of dementia. He really was looking for understanding and support as I had brought up my issues dealing with depression and anxiety after my heart attack and during my recovery. Again, I referred him to the CR staff.

Still another person asked me how long it took for me to feel '100%'. My answer was simply we are all different and we all heal at a different pace after bypass surgery. I told him that I still have issues with fatigue and lack of stamina but told him I also deal with T2 diabetes, a thyroid condition, sleep apnoea and angina and that it is not unusual two or three or even four times a week for me to have an afternoon nap.

Another person brought up the question of the need for people 'like us' who have been through the process getting into schools and talking to high school kids about what has happened to us, in many cases, as a result of poor lifestyle choices - smoking, alcohol, drugs, lack of exercise, poor diet etc. This is a topic which has always been close to my heart (pun intended) and something I wanted to see implemented by a heart support group I was involved in setting up in late 2008. Unfortunately, others in the group did not see this as a priority.

Having left that group and then becoming involved in our Heart Foundation as a volunteer speaker I was asked last year to give a talk to one of our local high schools and over 70 students were in attendance. The impact of someone who has been through process of a heart attack and bypass surgery should not be underestimated on the impressionable minds of teenagers and is why I believe it is so important for 'survivors', if they are up to it, to get involved in this sort of activity as well as sharing their experience with their family, children, grandchildren, church, social and sporting clubs and work colleagues.

All in all, the day's talk went very well and I look forward to the next one in April.

Talk given in Sep, 2011