Cognitive Change 1 Year after CEA or CAS Compared with Medication

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Background

Whether improvement of cognitive function can be maintained remains controversial.

Aims

This study aimed to investigate cognitive changes between before carotid endarterectomy (CEA) or carotid artery stenting (CAS) and 1 year after intervention using cognitive evaluation tools.

Methods

Patients suspected as having carotid stenosis were prospectively registered for evaluation of cognitive function from October 2011 to December 2013 in the Department of Neurosurgery, Fukuoka University Hospital. Cognitive evaluation by the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were performed before and 1 year after CEA or CAS. Cognitive changes were evaluated using the Wilcoxon signed rank test, whereas the subscores of MoCA and MMSE were also compared.

Results

The MoCA score was significantly ameliorated from 21 to 23 at 1 year after CEA (P = .003), but the MMSE score did not significantly change (24 to 25, P = .56). Additionally, the MoCA score was improved 1 year after CAS (P = .04), but it was unchanged in those who were treated medically (P = .15). Regarding the analyses of subscores, patients who had CEA improved in the areas of executive and memory functions, whereas those with medical treatment only showed improvement in memory. CAS did not improve any subscores. There was no significant improvement in the subscores of the MMSE in patients with CEA, CAS, or medical treatment 1 year after treatment compared with before treatment.

Conclusions

CEA or CAS may be significantly associated with cognitive improvement as evaluated by the MoCA. However, patients treated medically do not show improvement in cognitive performance.

Introduction

Clinically significant carotid stenosis causes subsequent ischemic stroke and death. We previously reported that carotid endarterectomy (CEA) improved immediate cognitive performance in patients with carotid stenosis.1 However, whether improvement of cognitive function can be maintained in patients with carotid stenosis who have undergone CEA previously remains controversial. There have been a few studies concerning the long-term effect of carotid stenosis on cognitive function.2, 3

Carotid artery stenting (CAS) is another carotid intervention option for patients with carotid stenosis. Unlike CEA, which requires general anesthesia, CAS is usually conducted under local anesthesia and contributes to diminishing the burden for its treatment.4 However, CAS has been reported to increase subsequent ischemic stroke more frequently than CEA. Regarding screening of cognition, CAS leads to improvement of cognitive performance.5, 6

The Montreal Cognitive Assessment (MoCA) is one of the screening tools for cognitive evaluation after stroke.7 However, whether the MoCA can evaluate cognitive performance of patients with carotid stenosis is unclear.

The current study aimed to investigate changes in cognition before and 1 year after carotid intervention using MoCA and MMSE scores. We compared those with cognition of patients with carotid stenosis who were treated medically.

Section snippets

Patients

Patients were prospectively registered when they were suspected as having significant carotid stenosis with a degree of carotid stenosis of ≥50% on computed tomography angiography or ultrasound in the Department of Neurosurgery, Fukuoka University Hospital. In this study, we included patients who were able to determine cognitive function both at initial and 1 year after treatment. We excluded the patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

Results

Carotid stenosis and cognitive function were initially assessed in 116 patients from October 2011 to December 2013, after 3 with apparent dementia were excluded (Fig 1). Of these, the cognitive function of 65 patients with CEA, 22 patients with CAS, and 29 with medication was determined. However, of these, only 73 patients were reviewed 1 year after the previous evaluation. Thus, we included the 73 patients in this study. CEA and CAS were performed in 39 and 11 patients, respectively, whereas

Discussion

The purpose of the current study was to evaluate changes in cognitive function using the MoCA and the MMSE between before and 1 year after CEA or CAS. We compared CEA or CAS with medical treatment. Our study suggested the following: (1) CEA and CAS improved the results of MoCA scores; (2) memory according to the MoCA was improved with CEA and medical treatment, which indicated a learning effect; and (3) the subscore of executive function as evaluated by the MoCA was significantly improved after

Acknowledgment

We thank Ms Asuka Ikezaki for her assistance.

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Funding: This work was supported in part by the Clinical Research Foundation in Japan. The sponsor had no role in the design or conduct of this research.

Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent: Informed consent was obtained from all individual participants included in this study.

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© 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.