{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:33:14Z","timestamp":1760146394831,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T00:00:00Z","timestamp":1730073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["RF-2016-02361069"],"award-info":[{"award-number":["RF-2016-02361069"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NeuroSci"],"abstract":"<jats:p>Background: Aortic valve stenosis (AVS) is a common valvular heart disease affecting millions of people worldwide. It leads to significant neurocognitive and neuropsychological impairments, impacting patients\u2019 quality of life. Objective: The objective of this article is to identify and discuss the potential neurocognitive effects on patients with aortic stenosis before and after undergoing surgical aortic valve replacement (SAVR). Method: Our study involved the assessment of 64 patients undergoing aortic valve replacement (SAVR) using a neurocognitive evaluation comprising a battery of 11 different cognitive tests. These tests were designed to analyze the patients\u2019 overall cognitive functioning, executive abilities, short- and long-term memory, and attentional performance. The tests were administered to patients before the aortic valve surgery (T0) and after the surgery (T1). From a statistical perspective, numerical variables are presented as means (\u00b1standard deviation) and medians (IQR), while categorical variables are presented as counts and percentages. Normality was assessed using the Shapiro\u2013Wilk test. T0 and T1 scores were compared with the Wilcoxon signed rank test, with p &lt; 0.05 considered significant. Analyses were performed using SAS version 9.4. Results: Conducted as part of a fully financed Italian Ministry of Health project (RF-2016-02361069), the study found that most patients showed normal cognitive functioning at baseline. Cognitive assessments showed that executive functions, attention, language, and semantic knowledge were within the normal range for the majority of participants. After SAVR, cognitive outcomes remained stable or improved, particularly in executive functions and language. Notably, verbal episodic memory demonstrated significant improvement, with the percentage of patients scoring within the normal range on the BSRT increasing from 73.4% at T0 to 92.2% at T1 (p &lt; 0.0001). However, visuospatial and visuoconstructive abilities showed stability or slight decline, while attentional skills remained relatively stable. The Clock Drawing Test indicated the maintenance of cognitive functions. Conclusions: The findings of our study indicate a global stability in cognitive status among patients after undergoing SAVR, with significant improvement noted in verbal episodic memory. While other cognitive domains did not demonstrate statistically significant changes, these insights are valuable for understanding the cognitive effects of SAVR and can guide future research and clinical practice in selecting the most effective surgical and rehabilitative options for patients. Monitoring cognitive outcomes in patients undergoing aortic valve replacement surgery remains crucial.<\/jats:p>","DOI":"10.3390\/neurosci5040035","type":"journal-article","created":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T09:51:26Z","timestamp":1730109086000},"page":"485-500","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pre- and Post-Operative Cognitive Assessment in Patients Undergoing Surgical Aortic Valve Replacement: Insights from the PEARL Project"],"prefix":"10.3390","volume":"5","author":[{"given":"Valentina","family":"Fiolo","sequence":"first","affiliation":[{"name":"Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8840-5859","authenticated-orcid":false,"given":"Enrico Giuseppe","family":"Bertoldo","sequence":"additional","affiliation":[{"name":"Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvana","family":"Pagliuca","sequence":"additional","affiliation":[{"name":"Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3144-9364","authenticated-orcid":false,"given":"Sara","family":"Boveri","sequence":"additional","affiliation":[{"name":"Laboratory of Biostatistics and Data Management, Scientific Directorate, IRCCS Policlinico San Donato, 20097 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8168-8254","authenticated-orcid":false,"given":"Sara","family":"Pugliese","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7132-2782","authenticated-orcid":false,"given":"Martina","family":"Anguissola","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9221-6153","authenticated-orcid":false,"given":"Francesca","family":"Gelpi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3396-6883","authenticated-orcid":false,"given":"Beatrice","family":"Cairo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5346-2677","authenticated-orcid":false,"given":"Vlasta","family":"Bari","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy"},{"name":"Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6720-9824","authenticated-orcid":false,"given":"Alberto","family":"Porta","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy"},{"name":"Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Callus","sequence":"additional","affiliation":[{"name":"Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy"},{"name":"Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/S0140-6736(09)60211-7","article-title":"Aortic stenosis","volume":"373","author":"Carabello","year":"2009","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Baumgartner, H., and Walther, T. (2018). Aortic stenosis. ESC CardioMed, Oxford University Press.","DOI":"10.1093\/med\/9780198784906.003.0766"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1093\/ehjci\/jew335","article-title":"Recommendations on the echocardiographic assessment of aortic valve stenosis: A focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography","volume":"18","author":"Baumgartner","year":"2017","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_4","unstructured":"Kaplan, J.A. (2017). Kaplan\u2019s Essentials of Cardiac Anesthesia E-Book, Elsevier Health Sciences."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1111\/imj.14071","article-title":"Contemporary review of severe aortic stenosis","volume":"49","author":"Adams","year":"2019","journal-title":"Intern. Med. J."},{"key":"ref_6","unstructured":"Istituto Italiano di Statistica (2024, March 13). Annuario Statistico Italiano (Italian Yearly Statistics). Rome, Italy. Available online: https:\/\/www.istat.it\/it\/archivio\/291790."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.bcp.2013.12.024","article-title":"Alzheimer disease: Epidemiology, diagnostic criteria, risk factors and biomarkers","volume":"88","author":"Reitz","year":"2014","journal-title":"Biochem. Pharmacol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s12471-012-0348-9","article-title":"The heart-brain connection: Mechanistic insights and models","volume":"21","author":"Ritz","year":"2013","journal-title":"Neth. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/B978-0-12-819814-8.00023-8","article-title":"The relationship between heart disease and cognitive impairment","volume":"177","author":"Miller","year":"2021","journal-title":"Handb. Clin. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e02176","DOI":"10.1002\/brb3.2176","article-title":"Cerebral blood flow impairment and cognitive decline in heart failure","volume":"11","author":"Ovsenik","year":"2021","journal-title":"Brain Behav."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1002\/ccd.26612","article-title":"Incidence and Clinical Impact of Stroke Complicating Transcatheter Aortic Valve Implantation: Results from the G erman TAVI Registry","volume":"88","author":"Werner","year":"2016","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.1016\/j.jacc.2014.07.986","article-title":"Imaging and functional testing to assess clinical and subclinical neurological events after transcatheter or surgical aortic valve replacement: A comprehensive review","volume":"64","author":"Spaziano","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1016\/S0140-6736(98)07576-X","article-title":"Neurobehavioural sequelae of cardiopulmonary b ypass","volume":"353","author":"Selnes","year":"1999","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/S0140-6736(06)69254-4","article-title":"Central nervous system injury associated with cardiac surgery","volume":"368","author":"Newman","year":"2006","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1007\/s40520-021-01969-x","article-title":"Surgical aortic valve replacement in elderly patients: Effects on physical performance, cognitive function and health-related quality of life","volume":"34","author":"Tarzia","year":"2022","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.athoracsur.2018.09.057","article-title":"Cognition and cerebral infarction in older adults after surgical aortic valve replacement","volume":"107","author":"Giovannetti","year":"2019","journal-title":"Ann. Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1080\/87565649109540545","article-title":"The mini-mental state examination: Normative study of an Italian random sample","volume":"9","author":"Measso","year":"1993","journal-title":"Dev. Neuropsychol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1007\/BF02333660","article-title":"Verbal and spatial immediate memory span: Normative data from 1355 adults and 1112 children","volume":"8","author":"Orsini","year":"1987","journal-title":"Ital. J. Neurol. Sci."},{"key":"ref_19","first-page":"278","article-title":"Tre test clinici di memoria verbale a lungo termine: Taratura su soggetti normali","volume":"47","author":"Novelli","year":"1986","journal-title":"Arch. Psicol. Neurol. Psichiatr."},{"key":"ref_20","first-page":"327","article-title":"Test di screening dei disturbi neuropsicologici dei colori: Dati normativi e attendibilita\u2019su un campione di cerebrolesi sinistri","volume":"57","author":"Galante","year":"1996","journal-title":"Arch. Psicol. Neurol. Psichiatr."},{"key":"ref_21","first-page":"44","article-title":"Standardizzazione e taratura italiana di test neuropsicologici","volume":"8","author":"Spinnler","year":"1987","journal-title":"Ital. J. Neurol. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1080\/13803395.2011.589373","article-title":"Italian norms for the Freedman version of the Clock Drawing Test","volume":"33","author":"Caffarra","year":"2011","journal-title":"J. Clin. Exp. Neuropsychol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/s10072-005-0443-4","article-title":"The Frontal Assessment Battery (FAB): Normative values in an Italian population sample","volume":"26","author":"Appollonio","year":"2005","journal-title":"Neurol. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/jgs.13198","article-title":"Impaired olfaction and risk of delirium or cognitive decline after cardiac surgery","volume":"63","author":"Morrissey","year":"2015","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1111\/jgs.14534","article-title":"Resting-state functional connectivity and cognition after major cardiac surgery in older adults without preoperative cognitive impairment: Preliminary findings","volume":"65","author":"Browndyke","year":"2017","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1097\/ALN.0b013e31821b1aab","article-title":"Preexisting cognitive impairment and mild cognitive impairment in subjects presenting for total hip joint replacement","volume":"114","author":"Evered","year":"2011","journal-title":"J. Am. Soc. Anesthesiol."}],"container-title":["NeuroSci"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2673-4087\/5\/4\/35\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:22:00Z","timestamp":1760113320000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2673-4087\/5\/4\/35"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,28]]},"references-count":26,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["neurosci5040035"],"URL":"https:\/\/doi.org\/10.3390\/neurosci5040035","relation":{},"ISSN":["2673-4087"],"issn-type":[{"type":"electronic","value":"2673-4087"}],"subject":[],"published":{"date-parts":[[2024,10,28]]}}}