Alteration of cognitive function has been reported in up to 30% of patients after CABG.371 374 The exact frequency depends on the timing of the postoperative assessment and the criteria used to measure cognitive decline.375,376 Studies with appropriate comparison groups (including nonsurgical and healthy control subjects) have demonstrated that most patients do not suffer cognitive decline as a result of CABG.377,378 For those who do, the postoperative cognitive changes are usually mild and generally resolve within 3 months of surgery.379 Long- term cognitive decline after CABG has been reported,380,381 but studies have shown that similar late cognitive decline occurs even among patients with CAD who do not undergo surgery, supporting that the decline is not related to the operation or the use of cardiopulmonary bypass.382 Cognitive changes have also been reported after general anesthesia for noncardiac Several risk factors for short-term postoperative cognitive decline have been identified, including preoperative factors for cerebrovascular disease, central nervous system disease, and preexisting cognitive impairment.371,386,387 It had previously been suggested that cognitive decline might be less frequent after off-pump CABG compared with on-pump surgery.388 As summarized in a meta-analysis, however, taken collectively, most studies failed to show a benefit of off-pump CABG In particular, large, robust, randomized, clinical trials comparing late cognitive outcomes after on-pump and off-pump CABG surgery reported no difference.390,391 Current findings therefore do not support a recommendation for off- pump surgery as an approach to prevent cognitive decline. Mental Health and Cognitive Decline Recommendations 1. For patients after CABG, it is reasonable to screen for depression in collaboration with a primary care physician and a mental health specialist (Class IIa; Level of Evidence B). 2. Cognitive behavior therapy or collaborative care for patients with clinical depression after CABG can be beneficial to reduce depression (Class IIa; Level of Evidence B). 