A Controlled Prospective Study of Neuropsychological Dysfunction Following Carotid Endarterectomy

Abstract

Subtle cognitive decline following CEA occurs and persists for at least several weeks after surgery. This decline was absent in a control group.

Elevation of monocyte chemoattractant protein-1 in patients experiencing neurocognitive decline following carotid endarterectomy

“…Each neuropsychological test was scored individually for CEA and LL patients as previously described [10]. The change in individual test scores from baseline to POD 1 was converted into Z-score relative to change within the LL group.…”

“…After obtaining informed consent, patients were evaluated with a battery of 5 neuropsychological tests before surgery and on POD 1. As described previously, a control group of 67 contempo-raneous patients undergoing lumbar laminectomy (LL) with a similar anaesthetic regimen were included to account for effects of general anesthesia on neuropsychological test performance [10]. All tests were performed more than 3 h after administration of any analgesic or sedative medication.…”

“…Patients (both CEA and LL) who reported a pain score of greater than 5 (on a 10-point scale) during testing were excluded from this study, as we have previously shown that pain confounds neuropsychological test performance [11]. All CEA and LL patients received general anesthesia with routine hemodynamic and temperature monitoring as previously described [10]. Surgical times averaged 155 ± 6 and 144 ± 6 min for the CEA and LL cohorts, respectively (mean ± SEM).…”

“…All patients were assessed pre-operatively and on POD 1 by a trained full-time research assistant using a battery of 5 neuropsychological tests chosen to represent a range of cognitive domains as we have described previously [9,10,12,16,17]. These tests are representative of the outcome measures recommended by a consensus group [19] along with tests used in previous studies of neuropsychological testing after carotid endarterectomy to better elucidate neurocognitive changes [1,13].…”

“…Three separate trials were performed at each testing session, one each with the letters C, F, and L. The Copy Portion of Rey Complex Figure test evaluated visuospatial organization, providing insight into the function of the nondominant hemisphere. Patients were instructed to copy the figure and a standardized scoring system was used to evaluate the presence of design-specific features and the accuracy of their locations [10].…”