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Effect of carotid endarterectomy on cognitive function in patients with asymptomatic carotid artery stenosis

  • Clinical Article - Vascular
  • Published:
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Abstract

Background

This study was conducted to determine if patients with asymptomatic carotid artery stenosis show cognitive function decline, and if they experience any changes in cognitive function after carotid endarterectomy (CEA).

Method

Cognitive function was examined in 15 patients (12 males and three females, 70.0 ± 6.5 years) with asymptomatic carotid artery stenosis before and 3 months after CEA. Cognitive function was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), two subtests of the Wechsler Adult Intelligence Scale-Revised (WAIS-R 2 subtests), and the Japanese version of National Adult Reading Test (JART). The patients’ average scores were compared with the normal average by one-sample t-tests, and the before and after scores were compared with paired t-tests. Changes in each patient were calculated from difference before and after CEA using 95 % confidence intervals.

Results

Before surgery, patients showed significant cognitive decline in RBANS total scale and immediate memory, language, and attention. At 3 months after CEA, the total scale and the immediate memory were not significantly different from the normal average. The average total scale score, the immediate memory and attention, and the WAIS-R 2 subtests scores were increased after treatment. Changes in each patient were calculated from the scores before and after CEA. At 3 months after CEA, the rate of increase in RBANS scores were 60.0 % of the patients for immediate memory, 26.7 % for visuospatial/constructional, 33.3 % for language and attention, 26.7 % for delayed memory, 47.7 % for total scale and 26.7 % for WAIS-R 2 subtests. Thus, so-called asymptomatic patients exhibit mild cognitive impairment before surgery, but after CEA, patients recover normal memory abilities.

Conclusions

Our findings of mild cognitive dysfunction in asymptomatic patients suggest that they might be symptomatic after all.

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References

  1. Aharon-peretz J, Tomer R, Gabrieli I, Aharonv D, Nitecki S, Hoffman A (2003) Cognitive performance following endarterectomy in asymptomatic severe carotid stenosis. Eur J Neurol 10:525–528

    Article  PubMed  CAS  Google Scholar 

  2. Cattell RB (1963) Theory of fluid and crystallized intelligence: a critical experiment. J Educ Psychol 54:1–22

    Article  Google Scholar 

  3. De Rango P, Caso V, Leys D, Paciaroni M, Lenti M, Cao P (2008) The role of carotid artery stenting and carotid endarterectomy in cognitive performance. A systematic review. Stroke 39:3116–3127

    Article  PubMed  Google Scholar 

  4. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995) Endarterectomy for asymptomatic carotid artery stenosis. JAMA 10:1421–1428

    Google Scholar 

  5. Falkensammer J, Oldenburg WA, Hendrak AJ, Neuhauser B, Pedraza O, Ferman T, Klocker J, Biebl M, Hugl B, Meschia JF, Hakaim AG, Brott TG (2008) Evaluation of subclinical cerebral injury and neuropsychologic function in patients undergoing carotid endarterectomy. Ann Vasc Surg 22:497–504

    Article  PubMed  Google Scholar 

  6. Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, Thomas D, MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group (2004) Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 363:1491–1502

    Article  PubMed  CAS  Google Scholar 

  7. Ikeda H (1985) Diagnosis of senile dementia. Hihon Rinsho 43:1390–1398

    CAS  Google Scholar 

  8. Landgraff NC, Whitey SL, Rubinsteni EN, Yonas H (2010) Cognitive and physical performance in patients with asymptomatic carotid artery disease. J Neurol 257:982–991

    Article  PubMed  Google Scholar 

  9. Martinic-Popovic I, Lovrencic-Huzian A, Demarin V (2009) Assessment of subtle cognitive impairment in stroke-free patients with carotid disease. Acta Clin Croat 48:231–240

    PubMed  Google Scholar 

  10. Mathiensen EB, Waterloo K, Joakimsen O, Bakke SJ, Jacobsen EA, Bonaa KH (2004) Reduced neuropsychological test performance in asymptomatic carotid stenosis: the Tromsø Study. Neurology 62:695–701

    Article  Google Scholar 

  11. Matsuoka K, Kin Y, Hiro H, Hiyamoto Y, Fujita K (2002) Japanese version of National Adult Reading Test (JART). Seishin Igaku 44:503–5011

    Google Scholar 

  12. Misawa G, Kobayashi S, Fujita K, Maekawa H, Dairoku H (1993) Japanese wechsler adult intelligence scale-revised short forms. Nihon Bunka Kagakusha, Tokyo

    Google Scholar 

  13. Randolph C (1998) RBANS Repeatable Battery for the Assessment of Neuropsychological Status Manual. The psychological corporation

  14. Rao R (2002) The role of carotid stenosis in vascular cognitive impairment. J Neurol Sci 203–204:103–107

    Article  PubMed  Google Scholar 

  15. Silvestrini M, Paolino I, Vernieri F, Pedone C, Baruffaldi R, Gobbi B, Cagnetti C, Provinciali L, Bartolini M (2009) Cerebral hemodynamics and cognitive performance in patients with asymptomatic carotid stenosis. Neurology 72:1062–1068

    Article  PubMed  CAS  Google Scholar 

  16. Shinagawa F, Kobayashi S, Fujita K, Maekawa H (2006) Japanese wecsler adult intelligence scale-revised. Nihon Bunka Kagakusha

  17. Takaiwa A, Kuwayama N, Hayashi N, Kubo M, Matsui M, Endo S (2006) Cognitive function in patients with severe carotid stenosis–evaluation of RBANS, WAIS-R, and NART before treatment of carotid revascularization–. No To Shinkei 58:681–686

    PubMed  Google Scholar 

  18. Takaiwa A, Hayahsi N, Kuwayama N, Akioka N, Kubo M, Endo S (2009) Changes in cognitive function during the 1-year period following endarterectomy and stenting of patients with high-grade carotid artery stenosis. Acta Neurochir 151:1593–1600

    Article  PubMed  Google Scholar 

  19. Yamashima T, Yoshida M, Kumahashi K, Matsui M, Koshino Y, Higashima M, Nagasawa T, Ueki A, Ohtsuka M, Aoki S, Imuro S, Mori N, Takei N, Hoshino R, Minabe Y, Nanba Y, Nanba M, Kira J, Ohyagi Y, Haraoka J, Akimoto J, Miura N, Kimura S, Matsushita M (2005) The Japanese version of RBANS (Repeatable Battery for the Assessment of Neuropsychological Steatus). No To Shinkei 54:463–471

    Google Scholar 

  20. Wanebo JE, Amin-Hanjini S, Boyd C, Peery T (2005) Assessing success after cerebral revascularization for ischemia. Skull Base 15:215–227

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Faculty of Medicine, University of Toyama, Sugitani 2630, Toyama, Toyama, 930-0194, Japan

    Akiko Takaiwa, Naoya Kuwayama, Naoki Akioka, Kunikazu Kurosaki, Nakamasa Hayashi, Shunro Endo & Satoshi Kuroda

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  1. Akiko Takaiwa
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  2. Naoya Kuwayama
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  3. Naoki Akioka
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  4. Kunikazu Kurosaki
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  5. Nakamasa Hayashi
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  6. Shunro Endo
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  7. Satoshi Kuroda
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Correspondence to Naoya Kuwayama.

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Takaiwa, A., Kuwayama, N., Akioka, N. et al. Effect of carotid endarterectomy on cognitive function in patients with asymptomatic carotid artery stenosis. Acta Neurochir 155, 627–633 (2013). https://doi.org/10.1007/s00701-013-1625-0

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  • DOI: https://doi.org/10.1007/s00701-013-1625-0

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