title: A controlled prospective study of neuropsychological dysfunction following carotid endarterectomy.
abstract: BACKGROUND
  Although subtle cognitive injury as revealed by neuropsychological testing occurs in a substantial number of patients following carotid endarterectomy (CEA), there is controversy about whether this finding is a result of the surgery or the anesthesia.
  
  
  OBJECTIVE
  To examine the changes in neuropsychological test performance in patients following CEA vs a control group of patients older than 60 years following spine surgery, so as to determine whether neuropsychological dysfunction after CEA is a result of surgery or anesthesia.
  
  
  METHODS
  Patients undergoing CEA (n = 80) and lumbar spine surgery (n = 25) were assessed with a battery of neuropsychological tests preoperatively and on postoperative days 1 and 30. The neuropsychological performance of patients in the control group was used to normalize performance for patients in the CEA group, by calculating z scores using the mean and SD of the change scores in the control group. Significant cognitive dysfunction was defined as performance that exceeded 2 SDs above the mean performance of patients in the control group.
  
  
  RESULTS
  Postoperative days 1 and 30 total deficit scores were significantly worse in the CEA group compared with the controls. When individual test results were examined, the CEA group performed significantly worse than the controls on the Rey Complex Figure test and Halstead-Reitan Trails B on day 1, and on the Rey Complex Figure on day 30. Overall, cognitive dysfunction was seen in 22 patients (28%) in the CEA group on day 1 and in 11 (23%) of 48 patients on day 30.
  
  
  CONCLUSIONS
  Subtle cognitive decline following CEA occurs and persists for at least several weeks after surgery. This decline was absent in a control group.
authors.affiliation: Department of Anesthesiology, Columbia University, 630 W 168th St, New York, NY 10032, USA. ejh3@columbia.edu
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Heyer
authors.forename: Ruchey
authors.initials: R
authors.lastname: Sharma
authors.forename: Anita
authors.initials: A
authors.lastname: Rampersad
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Winfree
authors.forename: William J
authors.initials: WJ
authors.lastname: Mack
authors.forename: Robert A
authors.initials: RA
authors.lastname: Solomon
authors.forename: George J
authors.initials: GJ
authors.lastname: Todd
authors.forename: Paul C
authors.initials: PC
authors.lastname: McCormick
authors.forename: James G
authors.initials: JG
authors.lastname: McMurtry
authors.forename: Donald O
authors.initials: DO
authors.lastname: Quest
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Stern
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Lazar
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000209:etiology*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications; D011446:Prospective Studies