Changes in Cognitive Function After Carotid Endarterectomy in Older Patients: Comparison With Younger Patients

Abstract

Objective and subjective assessments of changes in cognition after carotid endarterectomy (CEA) were compared between older patients (AE76 years old) and younger patients (º76 years old). Patients underwent subjective cognitive assessment by a neurosurgeon and the patient's next of kin, and neuropsychological testing (five parameters) before and after surgery. Of 37 older patients studied, 4 (11%), 28 (75%), and 5 (14%) patients were defined as having subjectively improved, unchanged, and impaired cognition, respectively, following surgery. Differences in test scores (postoperative test score -preoperative test score: D score) in all neuropsychological tests were significantly lower in the older patients than in the 213 younger patients. The D score was able to statistically differentiate older patients with subjectively improved, unchanged, and impaired cognition after surgery. Receiver operating characteristic analysis showed that the D score cut-off point for detecting subjective improvement (upper cut-off point) and impairment (lower cut-off point) in cognition after surgery in older patients was identical to the mean or the mean ＋0.5 standard deviation (SD) and the mean -1.5 SD or the mean -1 SD, respectively, of the control value obtained from normal subjects. The upper and lower cut-off points were lower and higher, respectively, than those in younger patients. In conclusion, although neuropsychological test scores reflect the subjective assessment of postoperative change in cognition in older patients, the optimal cut-off points for the test scores to detect subjective improvement and impairment in cognition after CEA are different in older patients compared with younger patients.

Convergence Analysis of Micro-Lesions (CAML): An approach to mapping of diffuse lesions from carotid revascularization

“…There also needs to be further study of the neural substrates of functional improvements and resilience. For example with respect to memory, there are some studies that find declines ( Aharon-Peretz et al, 2003 ; Heyer et al, 1998 ; Zhou et al, 2012 ) but an increasing number of studies demonstrate improvements or resilience against the lesions ( Aleksic et al, 2006 ; Bossema et al, 2005 ; Crawley et al, 2000 ; Ghogawala et al, 2013 ; Incalzi et al, 1997 ; Kim et al, 2015 ; Kougias et al, 2015 ; Kuliha et al, 2015 ; Migliara et al, 2013 ; Mononen et al, 1990 ; Ortega et al, 2014 ; Pearson et al, 2003 ; Piccetto et al, 2013 ; Takahashi et al, 2013 ; Wang et al, 2015 ; Xia et al, 2015 ; Xu et al, 2007 ; Zhou et al, 2017 ).…”

Mechanisms of Cognitive Improvement After Carotid Endarterectomy: Results of an Autopsy

“…As a result, postoperative improvement in each case could be detected with a sensitivity and specificity of 80% and above, which means that the pre-and postoperative score change in one of the five items of the WAIS-R (verbal IQ, performance IQ), WRS (MQ), or ROCF test (copy, recall) was the mean change in score of normal subjects + 2 standard deviations or more. It should be noted that these optimal pre-and postoperative score changes are data for patients younger than 76 years of age, and that the practice effect becomes less significant for patients older than 76 years of age, resulting in a smaller difference between pre-and postoperative scores [9] .…”

“…Although there are many factors involved, such as differences in the case groups analyzed, the most important reason for this is that the definition of "improvement in cognitive function" for each case is different and has not been clearly defined. In this review, we will describe the concept and definition of improvement in cognitive function after CEA, and then outline the mechanism of improvement based on our own experience [1,[9][10][11][12][13][14][15][16][17] . The study on which the following description is based was approved by the Ethics Committee of the University, including off-label use.…”

Neurocognitive dysfunctions and functional state of patients after internal carotid endarterectomy

“…Carotid endarterectomy (CEA) is a method of treatment of carotid stenosis, which significantly reduces the risk of ischemic stroke [1][2][3][4][5][6][7]. The efficacy and safety of CEA in symptomatic patients were randomized confirmed two key studies: NASCET (North American Symptomatic Carotid Endarterectomy Trial) and ECST (European Carotid Surgery Trial) [2,3].…”

“…There are publications which show that the internal carotid artery stenosis, as well as the operation of CEA, worsens cognitive functioning, while others show no improvement or any change in this area. They do not set clear guidelines for test methods or specific neuropsychological test battery for the assessment of cognitive functions, which should be used in patients with stenosis of the internal carotid artery after surgery or CEA [7,[9][10][11].…”