Changes in Cognition, Depression and Quality of Life after Carotid Stenosis Treatment

Abstract

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.

Differential Cognitive Functioning and Benefit From Surgery in Patients Undergoing Coronary Artery Bypass Grafting and Carotid Endarterectomy

“…There were also differences in postoperative changes in mood between the patient groups. In accordance with previous findings ( 60 ) we found no changes in depressive symptoms after CEA. In contrast, there were changes in mood after CABG in the present study: depressive symptoms were significantly higher in the acute phase and reduced in the stable phase compared with baseline.…”

Cognitive Functions in Patients after Carotid Artery Revascularization—A Narrative Review

“…A similar position was taken by Kim et al, who observed a significant improvement in memory and executive functions in patients after vascular interventions [41]. Other researchers recorded an increase in MoCA scores 6 and 12 months after CEA and 12 months after CAS, and no changes in the pharmacologically treated group [42]. In another study, improvement after CAS occurred in episodic, encoded, and working memory, as well as executive functions, while improvement after CEA affected episodic and encoded memory, as well as delayed recall.…”

“…As mentioned earlier, a review of the available literature suggests that carotid revascularization procedures improve cognitive performance, with no significant differences depending on the method [37,[39][40][41][42][43][44][45]. This view is also supported by Brajesh K. et al However, when comparing the results obtained by specific individuals in the study conducted by these authors, it is found that the post-CEA group performed better on psychomotor tests, while the post-CAS group performed better on memory and concentration tests.…”

Cognitive Functions after Carotid Artery Stenting—1-Year Follow-Up Study

“…Other researchers also confirmed the significant improvement of executive functions and memory after vascular interventions in patients with carotid atherosclerosis [ 37 , 38 , 39 , 40 , 41 , 42 ].…”