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BackgroundTo compare the six-month outcome on mood, cognition and quality of life (QoL) in patients with severe carotid atherosclerosis (CA) who underwent carotid endarterectomy (CEA) with subjects who refused treatment.MethodsCohort study on consecutive inpatients with CA (stenosis ≥ 50 %) (N = 46; age 72.56 ± 7.26; male 65.2 %). Intervention cohort: subjects who decided to undergo CEA (N = 35); Control cohort patients who refused CEA (N = 11). DSM-IV-Psychiatric diagnosis made by clinicians using interviews, QoL measured by Short Form Health Survey (SF-12); cognitive performance by WAIS Intelligent Coefficient (IC).ResultsThe study showed a better improvement during six months in Overall IC, Performance IC and Verbal IC in the group that underwent CEA. QoL in the two cohorts did not reach statistical significance. Percentages of patients who improved in the CEA group were significantly higher with regard to Overall and Verbal IC scores, and at the limits of statistical significance in Performance IC. The differences of subject with improvement in SF-12 score in the two groups did not reach statistical significance. Ages below 68 were found to be determinant of a good outcome in Overall IC score. Limit: study conducted with a small sample size.ConclusionsPatients with severe carotid atherosclerosis who underwent CEA enhanced their cognitive performance.

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Introduction/Objective:To study in severe carotid atherosclerosis (CA): the frequency of mood disorders (MD); the impairment of quality of life (QoL); the role of co-morbid MD in such impairment.Methods:Case-control study. Cases: consecutive in-patients with CA (stenosis ≥ 50%). Controls: subjects with no diagnosis of CA randomized from a database of a community survey. Psychiatric diagnosis according to DSM-IV made by clinicians and semi-structured interview, QoL measured by the Short Form Health Survey (SF-12).Results:This is the first study on comorbidity on CA disease and MD in which psychiatric diagnoses are conducted by clinicians according to DSM-IV diagnostic criteria. Major Depressive Disorder (MDD) (17.4% vs 2.72%, P <0.0001) but not Bipolar Disorders (BD) (4.3% vs 0.5%, P = 0.99) was higher in cases (N=46) than in controls (N= 184). SF-12 scores in cases were lower than in controls (30.56±8.12 vs 36.81±6:40; p <0.001) with QoL comparable to serious chronic diseases of the central nervous system. The burden of a concomitant MDD or BD amplifies QoL impairment.Conclusion:Comorbid MD aggravates the impairment of QoL in CA. Unlike autoimmune diseases or degenerative diseases of the Central Nervous System, CA shows a strong risk of MDD than BD.

Introduction: Investigating on brain local connectivity changes following Carotid Endarterectomy (CEA) by connectometry. Methods: In this exploratory study, seventeen subjects (15 males and 2 females, mean age 74.1 years) who underwent CEA, were prospectively recruited. Within one week before the CEA, each patient performed, in the same day, a cognitive evaluation with a Mini Mental State Examination (MMSE) and a Magnetic Resonance (MR) exam that included a DTI sequence for the connectometry analysis. The same cognitive test and MR protocol were performed on follow-up in a period between 3-6 months after CEA. The MMSE scores were analyzed using T-Student test. The connectometry analysis was performed using a multiple regression model in order to consider the effect of CEA, choosing three different T-score threshold values (1, 2 and 3), and results were considered statistically valid when p-value adjusted for False Discovery Rate (p-FDR) < 0.05. Results: Comparison of pre-CEA and post-CEA MMSE scores showed improvement of MMSE scores after CEA (p-value = 0.0001). Connectometry analysis revealed no areas of statistically significant increased connectivity related to CEA for T-threshold value = 1 and 2, whereas for Tthreshold value = 3 the analysis revealed statistically significant increased connectivity after CEA (p-FDR = 0.0106667) in both cerebellar hemispheres and corpus callosum. Conclusion: The results suggest that CEA procedure is associated with both improvements of cognitive performances and changes in both interhemispheric local connectivity through corpus callosum and in cerebellum.