Abstract
Introduction
With a growing number of older adults undergoing cardiac surgery, there is increasing emphasis on recovery outcomes beyond morbidity and survival. Many patients prioritise cognition and independence, yet these domains are not routinely assessed. Frailty, multimorbidity and cognitive vulnerability are common in this population, increasing risk of poor longer-term outcomes. However, longitudinal evidence describing cognitive and functional trajectories after surgery remains limited. We characterised cognitive and functional trajectories of older cardiac surgical patients over 5 years.
Methods
A prospective cohort study of adults aged ≥60 years undergoing elective coronary artery bypass grafting (CABG), with or without concomitant valvular surgery. Montreal Cognitive Assessment (MoCA) and Nottingham Extended Activities of Daily Living (NEADL) scale were recorded at baseline, discharge, 6 weeks, 6 months, and 5 years after surgery. MoCA trends were analysed using linear mixed effects modelling; NEADL with the Friedman test.
Results
130 patients were included (mean age 69 years; 96 male, 94 female; median Edmonton Frail Scale score 3). Mean MoCA declined from 25.5 (SD 3.4, n=123) at baseline to 24.0 at discharge, 22.7 at 6 weeks, 19.9 at 6 months, and 18.7 at 5 years (SD 3.6, n=59). Mixed effects modelling confirmed a significant change over time (F(4, 79.95) = 123.86, p<0.001).
NEADL scores decreased from 60 (range 28–66, n=127) to 33 at discharge, recovered to 55.5 at 6 weeks and exceeded baseline at 6 months (61.5) and 5 years (63). A Friedman test confirmed significant variation over time (χ²(4) = 33.791, p<0.001, n=25).
Conclusions
Older adults experience early and sustained cognitive decline over 5 years after cardiac surgery. In contrast functional recovery is rapid and improves to above baseline from 6 months to 5 years. These findings support routine cognitive and functional assessment to guide shared decision-making, especially regarding impact of surgery on cognitive recovery.