title: Neuropsychometric changes in patients after carotid endarterectomy.
abstract: OBJECTIVE
  One hundred twelve patients undergoing elective carotid endarterectomy for symptomatic and asymptomatic carotid artery stenosis were enrolled in a prospective study to evaluate the incidence of change in postoperative cerebral function.
  
  
  METHODS
  Patients were evaluated preoperatively and postoperatively before hospital discharge and at follow-up 1 and 5 months later with a battery of neuropsychometric tests. The results were analyzed by both event-rate and group-rate analyses. For event-rate analysis, change was defined as either a decline or improvement in postoperative neuropsychometric performance by 25% or more compared with a preoperative baseline.
  
  
  RESULTS
  Approximately 80% of patients showed decline in one or more test scores, and 60% had one or more improved test scores at the first follow-up examination. The percentage of declined test scores decreased and the percentage of improved test scores increased with subsequent follow-up examinations. Group-rate analysis was similar for group performance on individual tests. However, a decline in performance was seen most commonly on verbal memory tests, and improved performance was seen most commonly on executive and motor tests.
  
  
  CONCLUSIONS
  Neuropsychometric evaluation of patients undergoing carotid endarterectomy for significant carotid artery stenosis demonstrates both declines and improvements in neuropsychometric performance. The test changes that showed decreased performance may be associated with ischemia from global hypoperfusion or embolic phenomena, and the improvement seen may be related to increased cerebral blood flow from removal of stenosis.
authors.affiliation: Department of Anesthesiology, Columbia University, New York, NY 10032-3784, USA. ejh3@columbia.edu
authors.forename: E J
authors.initials: EJ
authors.lastname: Heyer
authors.forename: D C
authors.initials: DC
authors.lastname: Adams
authors.forename: R A
authors.initials: RA
authors.lastname: Solomon
authors.forename: G J
authors.initials: GJ
authors.lastname: Todd
authors.forename: D O
authors.initials: DO
authors.lastname: Quest
authors.forename: D J
authors.initials: DJ
authors.lastname: McMahon
authors.forename: S D
authors.initials: SD
authors.lastname: Steneck
authors.forename: T F
authors.initials: TF
authors.lastname: Choudhri
authors.forename: E S
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000523:psychology / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000150:complications / Q000523:psychology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000453:epidemiology* / Q000523:psychology; D011446:Prospective Studies; D011594:Psychometrics