<i>APOE</i>
            -ε4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy

Heyer, Éric; Wilson, David A.; Sahlein, Daniel; Mocco, J; Williams, Susan; Sciacca, Robert R.; Rampersad, Anita; Komotar, Ricardo J.; Zurica, Joseph; Benvenisty, Alan I.; Quest, Donald O.; Todd, George J.; Solomon, Robert A.; Connolly, E. Sander

doi:10.1212/01.wnl.0000184579.23624.6b

Cited by 68 publications

(65 citation statements)

References 31 publications

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“…Because the incidence of perioperative stroke is exceedingly rare, investigators are studying subtler forms of neurological injury, such as eCD, to increase the neurological safety of this commonly performed procedure. A number of studies have attempted to elucidate the underlying pathophysiology of this eCD, 3,12,13,18,20,21,31 because it is exhibited by approximately 25% of patients after CEA. This is the first study to evaluate the adequacy of cerebral collateral circulation as a predictor of eCD after CEA.…”

Section: Discussionmentioning

confidence: 99%

“…All CEA procedures were performed under general anesthesia with routine monitoring as well as continuous electroencephalographic monitoring to detect cerebral ischemia, as previously described. 3,12,13,18,20,21,31 An intraoperative CA shunt was placed in 4 patients with significant electroencephalographic changes consistent with cerebral ischemia, and these patients were subsequently excluded from this study. The remaining 38 patients were included in the statistical analysis.…”

Section: Study Subjectsmentioning

confidence: 99%

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Radiographic absence of the posterior communicating arteries and the prediction of cognitive dysfunction after carotid endarterectomy

Sussman¹,

Kellner

Mergeche³

et al. 2014

JNS

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Object Approximately 25% of patients exhibit cognitive dysfunction 24 hours after carotid endarterectomy (CEA). One of the purported mechanisms of early cognitive dysfunction (eCD) is hypoperfusion due to inadequate collateral circulation during cross-clamping of the carotid artery. The authors assessed whether poor collateral circulation within the circle of Willis, as determined by preoperative CT angiography (CTA) or MR angiography (MRA), could predict eCD. Methods Patients who underwent CEA after preoperative MRA or CTA imaging and full neuropsychometric evaluation were included in this study (n = 42); 4 patients were excluded due to intraoperative electroencephalographic changes and subsequent shunt placement. Thirty-eight patients were included in the statistical analyses. Patients were stratified according to posterior communicating artery (PCoA) status (radiographic visualization of at least 1 PCoA vs of no PCoAs). Variables with p < 0.20 in univariate analyses were included in a stepwise multivariate logistic regression model to identify predictors of eCD after CEA. Results Overall, 23.7% of patients exhibited eCD. In the final multivariate logistic regression model, radiographic absence of both PCoAs was the only independent predictor of eCD (OR 9.64, 95% CI 1.43–64.92, p = 0.02). Conclusions The absence of both PCoAs on preoperative radiographic imaging is predictive of eCD after CEA. This finding supports the evidence for an underlying ischemic etiology of eCD. Larger studies are justified to verify the findings of this study. Clinical trial registration no.: NCT00597883 (http://www.clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 99%

Section: Study Subjectsmentioning

confidence: 99%

Radiographic absence of the posterior communicating arteries and the prediction of cognitive dysfunction after carotid endarterectomy

Sussman¹,

Kellner

Mergeche³

et al. 2014

JNS

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“…Risk factors associated with patients that cannot be modified are: the advanced age (Shaw et al, 1987;Diijkstra et al, 1996;Roach et al, 1996;Moller et al, 1998;Abildstrom et al, 2000;Stockton et al, 2000;Ancelin et al, 2001;Newman et al, 2001;Canet et al, 2003;Monk et al, 2008), the educational status (Moller et al, 1998;Abildstrom et al, 2000;Ancelin et al, 2001;Newman et al, 2001;Monk et al, 2008) and the genetic polymorphism (considering apolipoprotein E4) (Abildstrom et al, 2004;Heyer et al, 2005;Lelis et al, 2006). The advanced age is associated with a large number of health problems, many of which can be successfully treated by surgical operations.…”

Section: Non-modifiable Patient Factorsmentioning

confidence: 99%

Risk Factors for the Development of Post-Operative Cognitive Dysfunction

Pappa¹,

Theodosiadis²,

Tsounis³

et al. 2016

GJHS

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Background: Many studies have shown that a large number of patients undergoing surgery show a measurable cognitive deterioration after surgery, while many of them still show cognitive deficits even three months later an operation. These specific cognitive deficits in which there is a temporal association between surgery and mental disorders are defined as postoperative impairment of cognitive function. Among cognitive disorders occurring during the postoperative period, the post-operative cognitive dysfunction (POCD) is less studied.Aim: Risk factors concerning POCD will be overviewed in order to be considered as a measure of prevention of POCD.Method: A literature search using combined keywords was undertaken on bibliographic databases including PubMed, Google Scholar and Scopus and through systematic selection 72 scientific articles were identified. Concerning the selection criteria, the material of this study consists of sources published mainly over the last fifteen years, while some articles that published before 2000 were selected because they were considered to be important.Results: These disorders frequently occur in patients of advanced age. It is obvious that as the population of humanity ages, many older people are likely to develop health problems that require surgery and therefore a large number of people are likely to develop post-operative cognitive disorders. For the appearance of POCD, as for other mental disorders (e.g. delirium), several factors are implicated. According to the findings, except the advanced age, genetic polymorphism, idiosyncratic condition, the presence of metabolic syndrome and neurological diseases, the type of anaesthesia and surgical operation and sleep disturbance are among the most important risk factors.

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“…48 Data are inconsistent regarding the role of the apolipoprotein ε4 genotype in perioperative cerebral injury. 2,4,43,87,91,94 Other investigators have examined for a relationship between polymorphisms of genes involved in pathways regulating coagulation, cell adhesion, and inflammation with perioperative cerebral injury. Grocott et al 39 found that the combination of 2 minor alleles of C-reactive protein (CRP; 3′UTR 1846C/T) and interleukin-6 (IL-6; -174G/C) were significantly associated with stroke after cardiac surgery (odds ratio, 3.3; 95% CI, 1.4 to 8.1; P=0.0023).…”

Section: Genetic Predispositionmentioning

confidence: 99%

Mechanisms of Cerebral Injury from Cardiac Surgery

Hogue

Gottesman

Stearns

2008

Critical Care Clinics

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Cerebral injury is a frequent complication of cardiac surgery and has been associated with high mortality, morbidity, hospital costs, and an increased likelihood of admission to a secondary care facility after hospital discharge, and impaired quality of life. 47,71,78,86 There are a variety of manifestations of perioperative cerebral injury including ischemic (or, less commonly, hemorrhagic) stroke that occurs in 1.5% to 5.2% of patients, encephalopathy affecting 8.4% to 32% of patients, and neurocognitive dysfunction affecting 20% to 30% of patients one month after surgery. 47,71,78,86 The range in reported incidences between studies is likely due to different patient populations (e.g., patient age and risk status, types of procedures), diagnostic definitions, and the intensity of clinical surveillance. Contemporary studies using sensitive brain MRI with diffusion weighted imaging report that as many as 45% of patients who have undergone cardiac surgery have new ischemic brain lesions that are often clinically undetected. 47,63The prevailing hypothesis, though not definitively proven, is that all forms of injury associated with cardiac surgery (i.e., stroke, encephalopathy, and neurocognitive dysfunction) have a similar etiology and that the manifestations depend on the extent and location of brain injury (e.g., motor cortex vs. areas subserving cognition). Many earlier studies that have described long-term neurocognitive changes after cardiac surgery have failed to include a non-surgical control group. 47,79 In a longitudinal study of patients with coronary artery disease undergoing either percutaneous coronary interventions or coronary artery bypass grafting (CABG), there were no differences in cognitive measures 36 months after either procedure. 88 These data imply that the effects of cardiac surgery on cognition may be short-lived (i.e., ~ 3 mo) and that progression of inherent cerebral vascular disease is a more important determinant of long-term cognitive decrements. These results further underscore the low sensitivity and specificity of psychometric testing for detecting cerebral injury in elderly populations with a high prevalence of preexisting cognitive impairment. 47In this paper, we will examine postulated mechanisms for cerebral injury from cardiac surgery. Most emphasis has been placed in the past on the intraoperative interval as being the period of highest cerebral vulnerability. Many clinical cerebral events, however, occur in the postoperative period. We have reported, in fact, that > 20% of clinical strokes occur after recovery from surgery and anesthesia. 45,71 Thus, patients must be considered vulnerable to cerebral injury any time during the perioperative period.

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APOE -ε4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy

Abstract: Background: Between 9% and 23% of patients undergoing otherwise uncomplicated carotid endarterectomy (CEA) develop subtle cognitive decline 1 month postoperatively. The APOE-ε4 allele has been associated with worse outcome following stroke. Objective: To investigate the ability

Cited by 68 publications

References 31 publications

Radiographic absence of the posterior communicating arteries and the prediction of cognitive dysfunction after carotid endarterectomy

Radiographic absence of the posterior communicating arteries and the prediction of cognitive dysfunction after carotid endarterectomy

Risk Factors for the Development of Post-Operative Cognitive Dysfunction

Mechanisms of Cerebral Injury from Cardiac Surgery

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