Cognitive function in patients with symptomatic dilated cardiomyopathy before and after cardiac transplantation.

Pre- and postoperative cognitive performance of candidates for heart transplantation was examined by means of an extensive battery of neuropsychological measures. A total of 54 patients completed the preoperative cognitive protocol, 20 of whom also completed postoperative testing. Age (less than 50 or greater than or equal to 50 years of age) and the primary cause of cardiac deterioration (idiopathic, ischemic disease or rheumatic/congenital defects) were the major classification variables. The main findings of this study were: 1) Preoperative neuropsychological measures revealed a high frequency of impaired performance, particularly in measures of memory, higher level processing of information and motor speed. A pattern consistent with diffuse rather than focal or lateralized cerebral deficits was observed. Significant differences were not found on the basis of the cause of cardiac disease, but some were observed for age (the older group was more impaired). 2) A comparison of pre- and postoperative cognitive scores failed to show significant cognitive improvement despite greatly improved physical health. The cause of cardiac deterioration was not differentially associated with postoperative cognitive performance, and there was equivocal evidence for age effects. These findings may have implications for the selection of transplant recipients and the timing of transplantation surgery.

Transcallosal parafornicial approach for third ventricle tumors: neuropsychological consequences.

Five adult patients with 3rd ventricle tumors underwent a transcallosal intraventricular parafornicial approach. Pre- and postoperative cognitive reviews were conducted on all patients. Each review consisted of: a standardized neuropsychological battery, mental status reviews, specific tests for disconnection, and a personality variable, where possible. Computed tomography and magnetic resonance imaging are also presented. The three patients with colloid cysts and the two with oligodendrogliomas showed no significant postoperative cognitive deficits compared to the preoperative review. These additional subtle neuropsychometric measures, along with the methodological advantage of preoperative review, support a parafornicial approach where indicated to preserve cognitive abilities.

Use of the MMPI and MMPI-2 in patients being evaluated for cardiac transplant.

The MMPI and MMPI-2 have been used extensively in the study of personality correlates in various coronary populations. It has been hypothesized that personality variables are associated with various clinical outcomes, such as quality of life, morbidity, and mortality; however, no data are available in a cardiac transplant sample. This study presents descriptive MMPI and MMPI-2 data for male and female patients awaiting cardiac transplant. Analyses of differences in MMPI-2 depression scales between cardiomyopathy groups for 366 men and 99 women were performed. Significant differences were found between ischemic and nonischemic male patients.

The effect of psychological intervention on patients' long-term adjustment to the ICD: a prospective study.

This study prospectively examined the role of cognitive behavioral therapy (CBT) in (1) alleviating psychological and somatic distress, and (2) lowering arrhythmic events requiring shocks. Forty-nine of 61 consecutive patients were randomized into therapy (CBT, n = 25) or no therapy (NT, n = 24) and completed a battery of self-report questionnaires at baseline and at 9-month follow-up. CBT was administered at preimplant, predischarge, and at seven routine follow-up visits. Patients were 65 +/- 10 years old, 65% were men, and 92% Caucasian. Eighteen (72%) CBT patients and 18 (75%) NT patients were retained at follow-up. Compared to CBT patients, NT patients reported higher levels of depression (P = 0.046), more anxiety (P = 0.013), more psychological distress (P = 0.015), poorer overall adjustment (P = 0.009), and poorer sexual functioning (P = 0.003). Mean number of shocks did not differ between the CBT and NT groups (2.85 vs 2.30, respectively); however, more patients in the CBT group (61%) than the NT group (33%) received shocks (P = 0.070). At follow-up, a subgroup analysis revealed that the significant differences observed between the CBT and NT groups were attributable to the patients who received shocks in both groups. In conclusion, CBT was associated with decreased depression, decreased anxiety, and increased adjustment for ICD recipients, particularly among those patients receiving shocks. CBT can be administered effectively at routine follow-up visits or transtelephonically with little added inconvenience to the ICD recipient.