Background: Although several studies have evaluated the change of cognitive performance after severe carotid artery stenosis, the results still remain elusive. The objective of this study was to assess changes in cognitive function, depressive symptoms and Health Related Quality of Life (HRQoL) after carotid stenosis revascularisation and Best Medical Treatment (BMT).Methods: Study involved 213 patients with ≥70% carotid stenosis who underwent assessment of cognitive function using Montreal Cognitive Assessment scale (MoCA), depressive symptoms - using Patient Health Questionnaire-9 (PHQ-9) and HRQoL - using Medical Outcome Survey Short Form version 2 (SF-36v2). The assessment was performed before and at 6 and 12 months follow-up periods in patients who had Carotid Endarterectomy (CEA), Carotid Artery Stenting (CAS) or received BMT only.Results: Improvement in the total MoCA scores was observed after 6 and 12 months (p<0.001, Kendall's W=0.28) in the CEA group. In the CAS group - after 12 months (p=0.01, Kendall's W=0.261) whereas in the BMT group - no significant changes (p=0.295, Kendall's W=0.081) were observed. Reduction of depressive symptoms was not found in any of the study groups. Comparing mean SF-36v2 scores in the CEA group, there was no significant difference in any of 10 subscales. Likewise in the CAS group - no significant difference in 9 of 10 subscales (p=0.028, η2=0.343) was observed. Three subscales worsened in the BMT group during the 1-year follow-up period.Conclusion: Patients with severe carotid stenosis who underwent revascularisation enhanced their cognitive performance without exerting significant change of depressive symptoms. Preoperative HRQoL may be maintained for at least one year in the CEA group.

Background:Carotid artery disease is not just a causal risk factor of ischemic stroke, but may predispose patients to depressive symptoms and low health related quality of life (HRQoL).Objectives:The objectives of the present study were to assess the association between severe carotid artery stenosis (CAS) and cognitive impairment, frequency of depressive symptoms and status of HRQoL.Methods:Cross - sectional study involved 55 patients with severe CAS and 54 patients with lower extremity peripheral artery disease (PAD). Cognitive impairment was assessed using Montreal Cognitive Assessment Scale (MoCA), depressive symptoms - PHQ-9 scale. HRQoL was measured using Medical Outcome Survey Short Form version 2 (SF-36v2).Results:Median MoCA score 24 [23;26] was significantly lower in patients with severe CAS than in patients with PAD - 26 [25-28],(p=0.005; effect size r=0.3). There was no statistically significant difference of median PHQ-9 scores the in CAS group (median PHQ-9 score 4.0 [5]) and in the PAD group (median PHQ-9 score 5.5 [7]), (p=0.08, effect size r=0.18). Mean SF-36v2 scores were similar in CAS and PAD groups except for bodily pain (p=0.001, Cohen's d value = 0.77) and vitality (p=0.02, Cohen's d value = 0.49).Conclusion:In summary, our findings indicate that severe CAS could play a role in cognitive decline. Further studies should be conducted using larger patient cohorts without ischemic brain lesions and with balanced vascular risk profiles to investigate impact of CAS on cognition. There was no association between severe CAS and depressive symptoms in the present study. As patients with severe CAS did not exhibit physical symptoms, HRQoL was better for those patients than for patients with lower extremity PAD.

OBJECTIVES:This study aims to evaluate the impact of carotid endarterectomy (CEA) on cognitive performance in patients with severe carotid disease and depressive symptoms, and to explore the possible associations between certain demographics, clinical characteristics, and cognitive function and depression. MATERIALS AND METHODS:The study included 48 patients, who were referred for endarterectomy. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) scale, while depressive symptoms were assessed using the patient health questionnaire(PHQ-9) scale. An assessment of cognitive and depressive symptoms was performed 1-3 days before surgery, and then six months after. RESULTS:A paired sample t-test found that the difference in the mean MoCA score between the before ( =23.37; SD ± 3.27) and the after ( =24.69; SD ± 3.68) surgery results was 1.32 (95% CI = 0.48 -2.16; p= 0.003; Cohen's d value = 0.95). A paired sample t-test showed that a decrease in mean PHQ-9 score of > 10 for patients six months after CEA (7.5±4.6) was statistically significant (p= 0.019; Cohen's d value = 1.32) compared with the PHQ-9 scores at baseline (12.6 ± 2.8). CONCLUSION:Carotid artery endarterectomy seems to have beneficial effects on the course of cognitive impairment and depressive symptoms in patients with severe carotid artery stenosis. Demographic, clinical characteristics (age, gender, comorbidities, previous stroke) did not have impact on course of cognitive and depressive symptoms. A limitation in our study was that the number of patients was relatively small, therefore we intend to perform further study with larger case volume to estimate the impact of carotid artery endarterectomy on cognitive functions and depressive symptoms.