{'fraction_non_alphanumeric': 0.022664199814986123, 'fraction_numerical': 0.012488436632747455, 'mean_word_length': 5.4183976261127595, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Coronary Revascularization and Cognitive Decline: The Patient or the Procedure?

Patients who undergo coronary revascularization are at increased risk for postprocedure cognitive impairment. Whether this outcome is due to the revascularization procedure or to the underlying shared vascular risk factors known to cause both coronary artery disease and dementia is unclear. Hypertension, diabetes, hyperlipidemia, smoking, and obesity all contribute to the development of coronary artery disease, and thus the need for revascularization, but also are known to increase the risk of cognitive decline and dementia, especially when present in middle age. 1–3 Furthermore, cardiac disease appears to be a risk factor for poor cognition, 4 and sequelae of cardiac disease, such as atrial fibrillation 5 or heart failure, 6 may increase the risk of poor cognitive outcomes. As a result, it can be challenging to disentangle the long-term cognitive effects related to coronary revascularization procedures, which are commonly performed among individuals with these vascular risk factors, from the effects associated with these underlying risk factors. In this issue of JAMA, 7 Whitlock and colleagues analyzed data from the community-based, observational Health and Retirement Study Importantly, the authors evaluated cognitive trajectories after coronary revascularization procedures and also considered the cognitive trajectory of participants before these procedures. In this study, a memory score was generated for 1680 older adults who had undergone either coronary artery bypass grafting (CABG; n = 665) or percutaneous coronary intervention (PCI; n = 1015). This composite score was generated by combining direct performance on cognitive testing with proxy reports on cognitive status; patients with scores 3 years before as well as 3 years after a revascularization procedure were included. The memory score was normalized as a z score (ie, mean of 0, SD of 1 in a reference population of adults aged ≥72 years), and the minimum clinically important difference was a rate of memory decline of 0.048 memory units/y. When the rate of in this was compared before vs