WASHINGTON, D.C. -- While coronary artery bypass surgery routinely saves lives by bypassing clogged arteries, many patients have a 20 percent decline in motor function and other evidence of brain damage following surgery, a Wake Forest University Baptist Medical Center neuropsychologist said today.
"All of us would give 20 points off our golf game to avoid a major coronary or death," said Dr. David Stump, research associate professor of anesthesiology and neurology. "The good news is that you are alive and playing golf; the bad news is that you are not doing as well as you did."
The impact of these deficits is dependent on the patient's work and his hobbies, Stump told a session on dementia at a meeting of the Space and Underwater Research Group of the World Federation of Neurology. The meeting is being coordinated by the Stroke Research Center of the Wake Forest University Baptist Medical Center.
At a session on Tuesday, Stump had described how changes in the way doctors at the Wake Forest University Baptist Medical Center perform coronary artery bypass surgery had dramatically cut such post-operative deficits and how the researchers there are now testing drugs to further reduce the deficits. Nonetheless, many patients across the country still experience post-surgical deficits following coronary artery bypass surgery.
"If you have a motor decline, and you are a race car driver or a golfer or in a field that requires hand-eye coordination like a surgeon, you're going to be more affected than the person who has difficulty remembering names or maintaining a stream of thought," Stump said. But even that depends on the patient's profession. "If you are Johnny Cochrane and you suddenly have a language delay and can't remember names, O.J. would be in jail."
Sometimes, he said, the declines are long term. For instance, golfers typically have a 20 percent decline in their golf score. "That is actually self-reported by our patients. Six months after bypass, a year after bypass, their game hasn't returned.
"Is that significant? In a right handed person, your right hand is only 8 to 10 percent more coordinated than your left hand, so a 20 percent decline in coordination would be the equivalent of your right hand now being twice as uncoordinated as your left hand. If you try to write your name or eat with your left hand or throw a baseball with your left hand, that will give you some idea of the level of change."
Another problem for people with such deficits is handling multiple tasks at once. "If you are writing a letter and the phone rings, you can't do both."
These deficits often are initially undetected because most neuropsychological tests are given one at a time. "If you put in a distractor, an interference test, you find they do much worse than they would have preoperatively. So attention and concentration are greatly impaired."
Convalescing patients typically do only one thing at a time. "They have a tendency to go back to work too soon," Stump said. "They get back to work and the telephone is ringing, and it's overwhelming."
Stump said a 70-year-old person who is able to maintain an independent lifestyle, pre-bypass, may not be able to do so after bypass surgery. "The likelihood of your going to a nursing home will be greatly increased."
The four-day meeting -- the Congress on Cerebral Ischemia, Vascular Dementia, Epilepsy and CNS Injury: New Aspects of Prevention and Treatment from Space and Underwater Exploration -- concludes today at the Washington Marriott Wardman Park Hotel, formerly the Sheraton Washington.