Risk of cognitive decline in older patients after carotid endarterectomy: an observational study
Mario Bo1, Massimiliano Massaia, Stefania Speme
1Section of Gerontology, Department of Medical and Surgical Disciplines, University of Turin, Ospedale San Giovanni Battista-Molinette, Corso Bramante 88, 10126 Turin, Italy. mario.bo@unito.it
Insights
Patients with symptomatic left internal carotid artery (LICA) stenosis undergoing carotid endarterectomy (CE) face a higher risk of cognitive decline. This highlights the need to investigate optimal timing for CE in LICA and RICA disease.
Area of Science:
- Vascular Surgery
- Neurology
- Cognitive Science
Background:
- Carotid endarterectomy (CE) is a procedure to prevent stroke in patients with carotid artery stenosis.
- Cognitive decline is a potential complication after vascular interventions.
- The risk of cognitive decline may differ based on the location and symptomatic nature of carotid artery stenosis.
Purpose of the Study:
- To compare the risk of cognitive decline in patients undergoing CE for symptomatic left internal carotid artery (LICA) stenosis versus asymptomatic LICA disease or right internal carotid artery (RICA) disease.
- To identify patient groups at higher risk for post-procedural cognitive impairment.
Main Methods:
- Observational study in a vascular surgery day hospital.
- Included 103 patients (aged 65+) undergoing CE, with 50 having LICA disease (29 symptomatic).
- Cognitive function assessed using Mini-Mental State Examination (MMSE) and Clock tests (CLOX1, CLOX2) at baseline and after ~44 months follow-up.
Main Results:
- Patients with symptomatic LICA disease showed significantly lower MMSE, CLOX1, and CLOX2 scores post-procedure.
- Symptomatic LICA disease was associated with a greater risk of cognitive decline compared to other groups.
- No significant cognitive decline was observed in patients with asymptomatic LICA disease or RICA disease.
Conclusions:
- Symptomatic LICA disease undergoing CE poses a greater risk for cognitive decline.
- Further research is recommended to explore the impact of CE timing on cognitive function in LICA and RICA disease patients.
Objectives:
To determine whether patients undergoing carotid endarterectomy (CE) for symptomatic left internal carotid artery (LICA) stenosis have greater risk of cognitive decline than patients with asymptomatic LICA disease or right internal carotid artery (RICA) disease.
Design:
Observational.
Setting:
Vascular surgery day hospital.
Participants:
The analysis included 103 patients (mean age 72.6+/-7.0, 73 men), of whom 50 had LICA disease (29 symptomatic).
Measurements:
Cognitive function was evaluated (age- and education-adjusted Mini-Mental State Examination (MMSE), and Clock tests (CLOX1 and 2)) at baseline and at the end of the study period (average follow-up+/-standard deviation 44.4+/-14.3 months) in a sample of patients aged 65 and older, free from cognitive impairment, consecutively undergoing CE.
Results:
At the end of the study period, MMSE, CLOX1, and CLOX2 scores were significantly lower in patients with symptomatic LICA disease (P<.001, P<.001, and P=.002, respectively) and not in the other groups of patients. Patients with symptomatic LICA disease had greater risk of cognitive decline than other individuals according to MMSE score (F=5.18, P=.002) or CLOX1 and 2 scores (F=5.66, P=.001, and F=4.33, P=.006, respectively).
Conclusion:
Patients undergoing CE for symptomatic LICA disease appear to be at greater risk of cognitive decline than other subjects. These findings suggest that future studies should evaluate the effects on cognitive function of different timing for CE in patients with LICA and RICA disease.
