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Neurocognitive dysfunctions and functional state of patients after internal carotid endarterectomy
Affiliations- Klinika Chirurgii Naczyniowej i Angiologii UM Lublin, ul. Stanisława Staszica 16, 20-400 Lublin, Poland
- Samodzielna Pracownia Rehabilitacji Neurologicznej UM Lublin, ul. Staszica 4-6, 20-081 Lublin, Poland
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Abstract
Introduction. Carotid endarterectomy (CEA) is a method of treatment of carotid stenosis, which significantly
reduces the risk of ischemic stroke. This procedure may affect the patient’s neurocognitive functioning. The
aim of the study was to evaluate the occurrence of neurocognitive disorders and to determine the functional
status of the patients undergoing CEA.
Material and methods. The study group consisted of 102 people who underwent CEA. Studies were
performed preoperatively and repeated on the fourth postoperative day. The following scales were used: the
Mini-Mental State Examination (MMSE), Activities of Daily Living Scale (ADL), Instrumental Activities of Daily
Living (IADL) and the Hamilton Depression Rating Scale (HAM-D).
Results. The average number of points obtained by patients in the MMSE, both before and after surgery is
26 points to 30 that may be obtained, which shows a subtle cognitive impairment. Almost every patient showed
fitness both in terms of basic (ADL), as well as complex (IADL) activities before and after surgery.
Conclusions. Low or average level of cognitive performance is observed in most subjects, both before and
after CEA. There are many different factors that can affect the cognitive functions. The functional status of
patients stood without significant changes.
Abstract
Introduction. Carotid endarterectomy (CEA) is a method of treatment of carotid stenosis, which significantly
reduces the risk of ischemic stroke. This procedure may affect the patient’s neurocognitive functioning. The
aim of the study was to evaluate the occurrence of neurocognitive disorders and to determine the functional
status of the patients undergoing CEA.
Material and methods. The study group consisted of 102 people who underwent CEA. Studies were
performed preoperatively and repeated on the fourth postoperative day. The following scales were used: the
Mini-Mental State Examination (MMSE), Activities of Daily Living Scale (ADL), Instrumental Activities of Daily
Living (IADL) and the Hamilton Depression Rating Scale (HAM-D).
Results. The average number of points obtained by patients in the MMSE, both before and after surgery is
26 points to 30 that may be obtained, which shows a subtle cognitive impairment. Almost every patient showed
fitness both in terms of basic (ADL), as well as complex (IADL) activities before and after surgery.
Conclusions. Low or average level of cognitive performance is observed in most subjects, both before and
after CEA. There are many different factors that can affect the cognitive functions. The functional status of
patients stood without significant changes.
Keywords
endarterectomy, internal carotid artery, cognitive impairment, functional state
About this articleTitle
Neurocognitive dysfunctions and functional state of patients after internal carotid endarterectomy
Journal
Issue
Pages
86-92
Published online
2018-10-25
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798
Article views/downloads
804
DOI
Bibliographic record
Acta Angiologica 2018;24(3):86-92.
Keywords
endarterectomy
internal carotid artery
cognitive impairment
functional state
Authors
Dorota Kozak-Putowska
Joanna Iłżecka
Tomasz Zubilewicz
References (32)- Bonati LH, Dobson J, Featherstone RL, et al. International Carotid Stenting Study investigators. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet. 2015; 385(9967): 529–538.
- Barnett HJM, Taylor DW, Haynes RB, et al. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991; 325(7): 445–453.
- Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). The Lancet. 1998; 351(9113): 1379–1387.
- Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995; 273(18): 1421–1428.
- Halliday A, Mansfield A, Marro J, et al. MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 2004; 363(9420): 1491–1502.
- Mendonça CT, Fortunato JA, Carvalho CA, et al. Carotid endarterectomy in awake patients: safety, tolerability and results. Rev Bras Cir Cardiovasc. 2014; 29(4): 574–580.
- Takahashi Y, Ogasawara K, Matsumoto Y, et al. Changes in cognitive function after carotid endarterectomy in older patients: comparison with younger patients. Neurol Med Chir (Tokyo). 2013; 53(6): 353–359.
- Naylor AR, Ricco JB, Borst GJde, et al. Editor's Choice – Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). European Journal of Vascular and Endovascular Surgery. 2018; 55(1): 3–81.
- Yoshida K, Ogasawara K, Kobayashi M, et al. Improvement and impairment in cognitive function after carotid endarterectomy: comparison of objective and subjective assessments. Neurol Med Chir (Tokyo). 2012; 52(3): 154–160.
- Feliziani FT, Polidori MC, De Rango P, et al. Cognitive performance in elderly patients undergoing carotid endarterectomy or carotid artery stenting: a twelve-month follow-up study. Cerebrovasc Dis. 2010; 30(3): 244–251.
- Altinbas A, Zandvoort Mv, Berg Ev, et al. Cognition after carotid endarterectomy or stenting: A randomized comparison. Neurology. 2011; 77(11): 1084–1090.
- Davis JC, Hsiung GY, Bryan S, et al. Agreement between patient and proxy assessments of quality of life among older adults with vascular cognitive impairment using the EQ-5D-3L and ICECAP-O. PLoS One. 2016; 11(4): e0153878.
- Wilson DA, Mocco J, D'Ambrosio AL, et al. Post-carotid endarterectomy neurocognitive decline is associated with cerebral blood flow asymmetry on post-operative magnetic resonance perfusion brain scans. Neurol Res. 2008; 30(3): 302–306.
- Heyer EJ, Sharma R, Rampersad A, et al. A controlled prospective study of neuropsychological dysfunction following carotid endarterectomy. Arch Neurol. 2002; 59(2): 217–222.
- Mracek J, Holeckova I, Chytra I, et al. The impact of general versus local anesthesia on early subclinical cognitive function following carotid endarterectomy evaluated using P3 event-related potentials. Acta Neurochir (Wien). 2012; 154(3): 433–438.
- Takaiwa A, Kuwayama N, Akioka N, et al. Effect of carotid endarterectomy on cognitive function in patients with asymptomatic carotid artery stenosis. Acta Neurochir (Wien). 2013; 155(4): 627–633.
- Kougias P, Collins R, Pastorek N, et al. Comparison of domain-specific cognitive function after carotid endarterectomy and stenting. J Vasc Surg. 2015; 62(2): 355–361.
- Germano da Paz O, Guillaumon AT, Lopes TM, et al. Carotid stenting versus endarterectomy cognitive outcomes. Ann Vasc Surg. 2014; 28(4): 893–900.
- Soinne L, Helenius J, Tatlisumak T, et al. Cerebral hemodynamics in asymptomatic and symptomatic patients with high-grade carotid stenosis undergoing carotid endarterectomy. Stroke. 2003; 34(7): 1655–1661.
- Capoccia L, Speziale F, Gazzetti M, et al. Comparative study on carotid revascularization (endarterectomy vs stenting) using markers of cellular brain injury, neuropsychometric tests, and diffusion-weighted magnetic resonance imaging. J Vasc Surg. 2010; 51(3): 584–91, 591.e1.
- Korczyn AD, Vakhapova V. The prevention of the dementia epidemic. J Neurol Sci. 2007; 257(1-2): 2–4.
- Nicolaides AN, Kakkos SK, Kyriacou E, et al. Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) Study Group. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification. J Vasc Surg. 2010; 52(6): 1486–1496.e1.
- Popovic IM, Lovrencic-Huzjan A, Simundic AM, et al. Cognitive performance in asymptomatic patients with advanced carotid disease. Cogn Behav Neurol. 2011; 24(3): 145–151.
- Rexroth DF, Tennstedt SL, Jones RN, et al. Relationship of demographic and health factors to cognition in older adults in the ACTIVE study. J Aging Health. 2013; 25(8 Suppl): 128S–46S.
- Stein J, Luppa M, Maier W, et al. AgeCoDe Study Group. Assessing cognitive changes in the elderly: reliable change indices for the Mini-Mental State Examination. Acta Psychiatr Scand. 2012; 126(3): 208–218.
- Barker-Collo S, Feigin VL, Parag V, et al. Auckland Stroke Outcomes Study. Part 2: Cognition and functional outcomes 5 years poststroke. Neurology. 2010; 75(18): 1608–1616.
- McGuire LC, Ford ES, Ajani UA. Cognitive functioning as a predictor of functional disability in later life. Am J Geriatr Psychiatry. 2006; 14(1): 36–42.
- Opara J, Dmytryk J, Chromy M, et al. "Repty" stroke scale . "Repty" Scale for the evaluation of the degree of injury after cerebral stroke. Part I. Neurol Neurochir Pol. 1998; 32(4): 793–802.
- Landgraff NC, Whitney SL, Rubinstein EN, et al. Cognitive and physical performance in patients with asymptomatic carotid artery disease. J Neurol. 2010; 257(6): 982–991.
- Arts MHL, Collard RM, Comijs HC, et al. Physical frailty and cognitive functioning in depressed older adults: findings from the NESDO study. J Am Med Dir Assoc. 2016; 17(1): 36–43.
- O'Donnell MJ, Chin SL, Rangarajan S, et al. INTERSTROKE investigators, INTERSTROKE investigators. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010; 376(9735): 112–123.
- Carta MG, Lecca ME, Saba L, et al. Patients with carotid atherosclerosis who underwent or did not undergo carotid endarterectomy: outcome on mood, cognition and quality of life. BMC Psychiatry. 2015; 15: 277.