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

• Published in: World neurosurgery Vol. 121; pp. e200 - e206
• Main Authors: Robison, Trae R., Heyer, Eric J., Wang, Shuang, Caccappolo, Elise, Mergeche, Joanna L., Shah, Sohum S., Connolly, Edward Sander
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2019
• Subjects: Adult; Aged; Aged, 80 and over; Carotid endarterectomy; Carotid stenosis; Carotid Stenosis - surgery; Cognition Disorders - diagnosis; Cognition Disorders - surgery; Cognitive impairment; Early Diagnosis; Endarterectomy, Carotid - methods; Female; Humans; Male; Middle Aged; Neuropsychological Tests; Neuropsychometric assessment; Postoperative Care; Prospective Studies; Retrospective Studies; Treatment Outcome; Carotid stenosis; CD; Carotid endarterectomy; OR; CI; ROCF; eCD; eCI; COWAT; HVLT; SRT; Neuropsychometric assessment; CEA; Cognitive impairment
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.09.076

Carotid endarterectomy (CEA) is an effective treatment for the prevention of stroke in patients with carotid artery stenosis. We aimed to clarify the incidence and risk factors for early cognitive dysfunction (eCD) and early cognitive improvement (eCI), defined as change in cognitive performance ≤24 hours after surgery, using a battery of neuropsychometric tests. In total, 585 patients undergoing CEA were tested with neuropsychometric tests before and after surgery; 155 patients undergoing “simple” spine surgery were the reference group. Patient performance for each test was evaluated by z scores. Cognitive change was defined as eCD (or eCI) if: 1) patients had a z score ≤–2 (or ≥2) in ≥2 cognitive domains or 2) patients had mean z scores across all domains ≤–1.5 (or ≥1.5). Associations between the categorical cognitive outcomes and variables of interest were modeled using the proportional odds model. Of the 585 subjects, 24% had eCD, 6% had eCI, and 70% had “no change.” Patients who had eCD were more likely to be statin naïve (odds ratio [OR] 1.23 [1.03–1.48], P = 0.02) or women (OR 1.27 [1.06–1.53], P = 0.02). Those with eCI were less likely to have less formal education (OR 0.95 [0.90–1.00], P = 0.04) and less likely to have diabetes mellitus (OR 0.8 [0.65–0.99], P = 0.04). Patients having CEA may develop eCD or eCI postoperatively. Medications likely to be associated with less eCD are statins and aspirin, which correlate most strongly in asymptomatic patients. In addition to confirming previous findings, we found that women were more likely than men to develop eCD. More sex-specific studies and analysis are needed to better explore these findings. •Patients undergoing carotid endarterectomy (CEA) may have cognitive changes within 24 hours of surgery.•Of 576 patients with CEA, 24% suffered early cognitive dysfunction and 6% improvement.•Women were more likely to have worse cognitive outcomes.•Patients without diabetes were more likely to have better cognitive outcomes.