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Original article

Vol. 145 No. 5152 (2015)

Cognitive improvement in patients with carotid stenosis is independent of treatment type

  • Manuela Wapp
  • Regula Everts
  • Yuliya Burren
  • Frauke Kellner-Weldon
  • Marwan El-Koussy
  • Roland Wiest
  • Andrea Federspiel
  • Patrik Michel
  • Gerhard Schroth
DOI
https://doi.org/10.4414/smw.2015.14226
Cite this as:
Swiss Med Wkly. 2015;145:w14226
Published
13.12.2015

Abstract

Treatment of carotid artery stenosis decreases the long-term risk of stroke and may enhance cerebral blood flow. It is therefore expected to have the potential to prevent cognitive decline or even improve cognition over the long-term. However, intervention itself can cause peri-interventional cerebral infarcts, possibly resulting in a decline of cognitive performance, at least for a short time. We investigated the long-term effects of three treatment methods on cognition and the emotional state one year after intervention.

In this prospective observational cohort study, 58 patients with extracranial carotid artery stenosis (≥70%) underwent magnetic resonance imaging and assessment of cognition, mood and motor speed before carotid endarterectomy (n = 20), carotid stenting (n = 10) or best medical treatment (n = 28) (i.e., time-point 1 [TP1]), and at one-year follow-up (TP2). Gain scores, reflecting cognitive change after treatment, were built according to performance as (TP2 −TP1)/TP1.

Independent of the treatment type, significant improvement in frontal lobe functions, visual memory and motor speed was found. Performance level, motor speed and mood at TP1 were negatively correlated with gain scores, with greater improvement in patients with low performance before treatment.

Active therapy, whether conservative or interventional, produces significant improvement of frontal lobe functions and memory in patients with carotid artery disease, independent of treatment type. This effect was particularly pronounced in patients with low cognitive performance prior to treatment.

References

  1. Everts R, Wapp M, Burren Y, Kellner-Weldon F, El-Koussy M, Janne K, et al. Cognitive and emotional effects of carotid stenosis. Swiss Med Wkly. 2014;144:W13970.
  2. Sinforiani E, Curci R, Fancellu R, Facchinetti P, Mille T, Bono G. Neuropsychological changes after carotid endarterectomy. Funct Neurol. 2001;16:329–36.
  3. Wang Q, Zhou M, Zhou Y, Ji J, Raithel D QT. Effects of Carotid Endarterectomy on Cerebral Reperfusion and Cognitive Function in Patients with High Grade Carotid Stenosis: A Perfusion Weighted Magnetic Resonance Imaging Study. Eur J Vasc Endovasc Surg. 2015;50:5–12.
  4. Bo M, Massaia M, Speme S, Cappa G, Strumia K, Cerrato P, et al. Risk of cognitive decline in older patients after carotid endarterectomy: an observational study. J Am Geriatr Soc. 2006;54:932–6. doi:10.1111/j.1532-5415.2006.00787.x.
  5. Heyer EJ, Sharma R, Rampersad A, Winfree CJ, Mack WJ, Solomon RA, et al. A controlled prospective study of neuropsychological dysfunction following carotid endarterectomy. Arch Neurol. 2002;59:217–22.
  6. Berman L, Pietrzak RH, Mayes L. Neurocognitive changes after carotid revascularization: a review of the current literature. J Psychosom Res. 2007;63:599–612. doi:10.1016/j.jpsychores.2007.06.009.
  7. De Rango P, Caso V, Leys D, Paciaroni M, Lenti M, Cao P. The role of carotid artery stenting and carotid endarterectomy in cognitive performance: a systematic review. Stroke. 2008;39:3116–27. doi:10.1161/STROKEAHA.108.518357.
  8. Paraskevas KI, Lazaridis C, Andrews CM, Veith FJ GA. Comparison of cognitive function after carotid artery stenting versus carotid endarterectomy. Eur J Vasc Endovasc Surg. 2014;37:221–31.
  9. Plessers M, Van Herzeele I, Vermassen F, Vingerhoets G. Neurocognitive Functioning after Carotid Revascularization: A Systematic Review. Cerebrovasc Dis Extra. 2014;4:132–48. doi:10.1159/000362921.
  10. Borroni B, Tiberio G, Bonardelli S, Cottini E, Facheris M, Akkawi N, et al. Is mild vascular cognitive impairment reversible? Evidence from a study on the effect of carotid endarterectomy. Neurol Res. 2004;26:594–7. doi:10.1179/016164104225016245.
  11. Heyer EJ, Adams DC, Solomon RA, Todd GJ, Quest DO, McMahon DJ, et al. Neuropsychometric changes in patients after carotid endarterectomy. Stroke. 1998;29:1110–5.
  12. Mlekusch W, Mlekusch I, Minar E, Haumer M, Kopp CW, Ahmadi R, et al. Is there improvement of “vascular depression” after carotid artery stent placement? Radiology. 2006;240:508–14. doi:10.1148/radiol.2402051043.
  13. Bossema ER, Brand N, Moll FL, Ackerstaff RG, van Doornen LJ. Does carotid endarterectomy improve cognitive functioning? J Vasc Surg. 2005;41:775–81. doi:10.1016/j.jvs.2004.12.057.
  14. Fischer U, Baumgartner A, Arnold M, Nedeltchev K, Gralla J, De Marchis GM, et al. What is a minor stroke? Stroke. 2010;41:661–6. doi:10.1161/STROKEAHA.109.572883.
  15. Staikov IN, Arnold M, Mattle HP, Remonda L, Sturzenegger M, Baumgartner RW, et al. Comparison of the ECST, CC, and NASCET grading methods and ultrasound for assessing carotid stenosis. European Carotid Surgery Trial. North American Symptomatic Carotid Endarterectomy Trial. J Neurol. 2000;247:681–6.
  16. Staikov IN, Nedeltchev K, Arnold M, Remonda L, Schroth G, Sturzenegger M, et al. Duplex sonographic criteria for measuring carotid stenoses. J Clin Ultrasound. 2002;30:275–81. doi:10.1002/jcu.10078.
  17. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol. 1987;149:351–6. doi:10.2214/ajr.149.2.351.
  18. Scheltens P, Barkhof F, Leys D, Pruvo JP, Nauta JJ, Vermersch P, et al. A semiquantative rating scale for the assessment of signal hyperintensities on magnetic resonance imaging. J Neurol Sci. 1993;114:7–12.
  19. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, et al. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. 2001;32:1318–22.
  20. Ryan DJ, Byrne S, Dunne R, Harmon M, Harbison J. White matter disease and an incomplete circle of Willis. Int J Stroke. 2013. doi:10.1111/ijs.12042.
  21. Delis DC KJH. Delis-Kaplan Executive Function System 2001.
  22. Von Aster M, A. N, Horn R. Wechsler Intelligenztest für Erwachsene WIE. Übersetzung und Adaption der WAIS-III von David Wechsler [German adaption of the WAIS-III]. Pearson Assessment. Frankfurt, Germany; 2006.
  23. Memory Clininc CERAD-Plus. CERAD-Plus 2009. http://www.memoryclinic.ch/content/view/37/47/. 2009. 21-07-2009.
  24. Helmstaedter C, Lendt M, Lux S. Verbaler Lern- und Merkfähigkeitstest (VLMT). Weinheim: Beltz; 2001.
  25. Rey A. L’examen clinique en psychologie [The clinical examination of psychology]. Press Universitaire de France. Paris, France; 1964.
  26. Rey A. Manuel du test de copie d’une figure complexe de A. Rey [Manual for testing copying of the Rey Figure]. Centre de Psychologie Appliquée. Paris, France; 1959.
  27. Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests: administration, norms, and commentary. 3rd ed. Oxford; New York: Oxford University Press; 2006.
  28. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.
  29. Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clement D, Collet JP, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatm. Eur Hear J. 2011;32:2851–906. doi:10.1093/eurheartj/ehr211.
  30. Abdi H. The Bonferonni and Šidák Corrections for Multiple Comparisons. 2007. doi:10.4135/9781412952644.
  31. Ortega G, Alvarez B, Quintana M, Ribo M, Matas M, Alvarez-Sabin J. Cognitive improvement in patients with severe carotid artery stenosis after transcervical stenting with protective flow reversal. Cerebrovasc Dis. 2013;35:124–30. doi:10.1159/000346102.
  32. Xu G, Liu X, Meyer JS, Yin Q, Zhang R. Cognitive performance after carotid angioplasty and stenting with brain protection devices. Neurol Res. 2007;29:251–5. doi:10.1179/016164107X159216.
  33. Grunwald IQ, Papanagiotou P, Reith W, Backens M, Supprian T, Politi M, et al. Influence of carotid artery stenting on cognitive function. Neuroradiology. 2010;52:61–6. doi:10.1007/s00234-009-0618-4.
  34. Fearn SJ, Hutchinson S, Riding G, Hill-Wilson G, Wesnes K, McCollum CN. Carotid endarterectomy improves cognitive function in patients with exhausted cerebrovascular reserve. Eur J Vasc Endovasc Surg. 2003;26:529–36.
  35. Yoon B-A, Sohn SW, Cheon S-M, Kim D-H, Cha J-K, Yi, SoJeong Park KW. Effect of Carotid Artery Stenting on Cognitive Function in Patients with Carotid Artery Stenosis: A Prospective, 3-Month-Follow-Up Study. J Clin Neurol. 2015;11:149–56.
  36. Baracchini C, Mazzalai F, Gruppo M, Lorenzetti R, Ermani M, Ballotta E. Carotid endarterectomy protects elderly patients from cognitive decline: A prospective study. Surgery. 2012;151(1):99–106
  37. Sztriha LK, Nemeth D, Sefcsik T, Vecsei L. Carotid stenosis and the cognitive function. J Neurol Sci. 2009;283:36–40. doi:10.1016/j.jns.2009.02.307.
  38. Ghogawala Z, Amin-Hanjani S CJ, Ciarleglio M, Berenstein A, Stabile L WM. The Effect of Carotid Endarterectomy on Cerebral Blood Flow and Cognitive Function. J Stroke Cerebrovasc Dis. 2013;22:1029–37.
  39. Crawley F, Clifton A, Buckenham T, Loosemore T, Taylor RS, Brown MM. Comparison of hemodynamic cerebral ischemia and microembolic signals detected during carotid endarterectomy and carotid angioplasty. Stroke. 1997;28:2460–4.
  40. Lacroix V, Hammer F, Astarci P, Duprez T, Grandin C, Cosnard G, et al. Ischemic cerebral lesions after carotid surgery and carotid stenting. Eur J Vasc Endovasc Surg. 2007;33:430–5. doi:10.1016/j.ejvs.2006.11.012.
  41. Altinbas A, van Zandvoort MJ, van den Berg E, Jongen LM, Algra A, Moll FL, et al. Cognition after carotid endarterectomy or stenting: a randomized comparison. Neurology. 2011;77:1084–90. doi:10.1212/WNL.0b013e31822e55b9.
  42. Wasser K, Hildebrandt H, Gröschel S, Stojanovic T, Schmidt H, Gröschel K, Pilgram-Pastor SM, Knauth M KA. Age-dependent effects of carotid endarterectomy or stenting on cognitive performance. J Neurol. 2012;259:2309–18.
  43. Heyer EJ, DeLaPaz R, Halazun HJ, Rampersad A, Sciacca R, Zurica J, et al. Neuropsychological dysfunction in the absence of structural evidence for cerebral ischemia after uncomplicated carotid endarterectomy. Neurosurgery. 2006;58:474–80. doi:10.1227/01.NEU.0000197123.09972.EA.
  44. Mocco J, Wilson DA, Komotar RJ, Zurica J, Mack WJ, Halazun HJ, et al. Predictors of neurocognitive decline after carotid endarterectomy. Neurosurgery. 2006;58:844–50. doi:10.1227/01.NEU.0000209638.62401.7E.
  45. Bonati LH, Jongen LM, Haller S, Flach HZ, Dobson J, Nederkoorn PJ, et al. New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol. 2010;9:353–62. doi:10.1016/S1474-4422(10)70057-0.

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