Cognitive deficits following coronary artery bypass grafting: prevalence, prognosis, and therapeutic strategies

There is increasing recognition that coronary artery bypass grafting (CABG) may be a risk factor for subtle cognitive decline although the presence and pattern of such decline has varied across studies. Cognitive deficits may present as short-term memory loss, executive dysfunction and psychomotor slowing. Although they are usually are not severe enough to meet criteria for mild cognitive impairment or vascular dementia, they lower quality of life and add to hospitalization and out-of-hospital costs. Proposed mechanisms include surgical-related trauma, genetic susceptibility (eg, apolipoprotein E4 allele), microembolization, other vascular or ischemic changes, and temperature during surgery. Depression and anxiety levels predict subjective perception of these deficits more than objective cognitive performance. Both nonpharmacologic (eg, emboli reduction, temperature, or glucose management) and pharmacologic (eg, dexanabinol, glypromate, nootropics) strategies to prevent post-CABG cognitive deficits are under investigation. Given the large numbers of subjects who may already have CABG associated cognitive deficits, clinical trials of agents being tested for Alzheimer's disease (eg, donepezil, rivastigmine, memantine, neramexane, ginkgo) may also be informative. The results of multicenter long-term outcome studies (with matched control groups) as well as ongoing treatment trials will more conclusively address some of these issues. These data emphasize the need for clinicians to monitor cognitive function before and after coronary bypass surgery, and to educate patients.     

Differential effect of ill-being and chronic stress on cradling behavior of first and multi-time parents

A preference for cradling infants on the left side has been demonstrated in women, as has a relation of reduced left-cradling and stress/negative affect. This relation has not yet been investigated in male participants. Due to less left-cradling in non-fathers compared to fathers it was suggested that fatherhood might have an influence on cradling behavior. The present study investigated the cradling preference of first- and multi-time parents before and after birth, and its relation to ill-being and stress. Results revealed that cradling behavior of first-time fathers was not different before and after the birth of the infant. Thus, fatherhood does not seem to have an acute influence on cradling behavior. Furthermore, cradling behavior of first- and multi-time parents was differentially influenced by ill-being and stress.These results present new information about the course of cradling preference from pregnancy to postpartum and indicate that the relation of cradling and ill-being/stress is more complex for parents than for non-parents.     

Review Essay

Pastoral Psychology -     

Directed attention influences the modification of startle reflex probability

The present study was designed to investigate the effect of directed attention on elicitation and modification of the startle reflex. 30 adult human subjects received 90 dB(A) broadband noise startle stimuli either alone or preceded by a 60 dB(A) prepulse (either 2000-Hz tone, 1000-Hz tone, or broadband noise). Subjects were instructed to attend to one of the three prepulses during half the trials and to ignore all stimuli during the rest of the trials. The probability of responding while attending to a prepulse was significantly lower than the probability of responding while ignoring the prepulses. Responding to the prepulses was also more probable while subjects were attending to the prepulses, and these effects were more pronounced for tone than for noise prepulses. These results suggest that directed attention can influence the probability of the startle reflex without influencing startle amplitude or latency.     

Social support and prognosis in patients at increased psychosocial risk recovering from myocardial infarction.

OBJECTIVE: To compare the impact of network support and different types of perceived functional support on all-cause mortality or nonfatal reinfarction for patients with a recent acute myocardial infarction (AMI). DESIGN: Participants were recruited from the Enhancing Recovery in Coronary Heart Disease (ENRICHD) trial; 2,481 AMI patients with depression or low social support were randomized to a cognitive-behavioral intervention or to a usual care control group. Data collection for certain measures of social support was limited: 2,466 participants completed the ENRICHD Social Support Inventory; 2,457 completed the Perceived Social Support Scale; 1,296 completed the Social Network Questionnaire; and 707 completed the Interpersonal Support and Evaluation List, Tangible Support subscale. Patients also completed the Beck Depression Inventory and were followed for up to 4.5 years. MAIN OUTCOME MEASURE: Time to death or nonfatal reinfarction. RESULTS: Over the follow-up period, 599 patients (24%) died or had a nonfatal AMI. Survival models controlling age, sex, race, socioeconomic status, smoking, antidepressant use, and a composite measure of increased risk revealed that higher levels of perceived social support were associated with improved outcome for patients without elevated depression but not for patients with high levels of depression. Neither perceived tangible support nor network support were associated with more frequent adverse events. CONCLUSION: AMI patients should be assessed for multiple dimensions of perceived functional support and depression to identify those at increased psychosocial risk who may benefit from treatment.     

Inhibition of acoustic startle using different mechanoreceptive channels

In this experiment, we investigated the impact of vibrotactile prepulse frequency and intensity on the acoustically elicited startle response in humans. Mechanoreceptive channels differing in their sensitivity to transient stimulation have been identified in the skin. The Pacinian channel is optimally sensitive to vibrations at approximately 300 Hz and is specialized for the detection of stimulus transients, whereas the non-Pacinian I and III channels are optimally sensitive to vibrations at approximately 30 Hz. Vibrotactile prepulses with frequencies of 30 and 300 Hz and intensities of 95 and 130 mV were presented for 50 msec to the dominant hand of college students (N = 31), followed on some trials by a 95-dB broadband acoustic startle stimulus. The 300-Hz prepulses resulted in significantly more pronounced inhibition of startle magnitude, amplitude, and probability, whereas only the 30-Hz prepulses significantly facilitated blink latency. These results support the idea that the inhibition of acoustic startle is determined more by transient than by sustained aspects of vibrotactile prepulse stimuli. This study also demonstrates that different aspects of the startle response differentially reflect stimulus characteristics of the prepulse.     

Property law: A cognitive turn

Despite more than a century of research by psychologists on issues relating to the law, most such research has focused on a small subset of topics relevant to the legal system. Here, I review several legal topics amenable to psychological research that fall under the broad umbrella of property law: (1) how the concepts of property and ownership are represented cognitively; (2) the relationship between wealth and happiness, consumer behavior, and the priming effect of money concepts; (3) animal and child development in cognition about and behavior toward property and ownership; and (4) the relevance of psychological research on home to legal policy. These and other areas provide potential research agendas for cognitive and social cognitive psychologists. After noting the importance of such research for legal doctrine, theory, and policy, I close with suggestions for effectively communicating empirical findings to the legal community.