Easily Screenable Characteristics Associated with Cognitive Improvement and Dysfunction After Carotid Endarterectomy

Area of Science:

• Neurology
• Vascular Surgery
• Cognitive Science

Background:

• Carotid endarterectomy (CEA) is a key stroke prevention strategy for carotid artery stenosis.
• Early cognitive dysfunction (eCD) and improvement (eCI) post-CEA require further investigation.
• Neuropsychometric tests are crucial for assessing cognitive changes after surgical interventions.

Purpose of the Study:

• To determine the incidence of early cognitive dysfunction (eCD) and early cognitive improvement (eCI) following CEA.
• To identify risk factors associated with eCD and eCI after carotid endarterectomy.
• To compare cognitive changes in CEA patients with a reference group undergoing spine surgery.

Main Methods:

• 585 patients undergoing CEA and 155 undergoing spine surgery were assessed using neuropsychometric tests pre- and post-operatively.
• Cognitive performance was evaluated using z scores, with specific thresholds defining eCD and eCI.
• Proportional odds models were employed to analyze associations between cognitive outcomes and patient variables.

Main Results:

• 24% of CEA patients experienced eCD, 6% had eCI, and 70% showed no significant cognitive change.
• Factors associated with eCD included being statin-naive (OR 1.23) and female sex (OR 1.27).
• eCI was linked to less formal education (OR 0.95) and lower incidence of diabetes mellitus (OR 0.8).

Conclusions:

• Postoperative cognitive dysfunction or improvement is common after CEA.
• Statins and aspirin may reduce eCD, particularly in asymptomatic patients.
• Women exhibit a higher likelihood of developing eCD post-CEA, warranting further sex-specific research.