Does carotid endarterectomy improve cognitive functioning?
BACKGROUND
Carotid endarterectomy (CEA) might improve cognitive functioning, but studies thus far have produced mixed results. The aim of the present study was to examine the effect of CEA on cognitive functions in a methodologically more strict design, first by testing the presumption of preoperative cognitive impairment and second through a better control for the possible influence of the nonspecific effects of practice and surgery.


METHODS
Preoperative performance on a neuropsychologic test battery of 56 patients with severe occlusive disease of the carotid artery but without history of major stroke was compared with the performance of 46 healthy control subjects and 23 patients before endarterectomy of the superficial femoral artery (remote endarterectomy). The degree of cognitive change in the 2 patient groups was compared at 3 and 12 months postoperatively. We assessed mood to control for possible momentary affective influences on cognition.


RESULTS
Before CEA, patients showed reduced functioning compared with that seen in healthy control subjects in terms of attention, verbal and visual memory, planning of motor behavior, psychomotor skills, and executive function. Performance of patients before remote endarterectomy was reduced as well. Improvements in several cognitive functions were observed after both types of surgical interventions and were attributed to psychologic relief from uncomplicated surgery and to practice.


CONCLUSIONS
No specific restorative effect of CEA on cognitive functioning was observed. The preoperative impairment in several cognitive domains might be caused by factors that patients with various types of vascular disease might have in common, such as small-vessel disease or other undetected abnormalities within the brain.
Bossema
Ercolie R
ER
Deartment of Health Psychology, Utrecht University, 3508 TC Utrecht, The Netherlands. e.r.bossema@fss.uu.nl
Brand
Nico
N
Moll
Frans L
FL
Ackerstaff
Rob G A
RG
van Doornen
Lorenz J P
LJ
D000368:Aged; D001288:Attention / Q000502:physiology; D016893:Carotid Stenosis / Q000523:psychology / Q000601:surgery*; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000503:physiopathology*; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008182:Luria-Nebraska Neuropsychological Battery; D008297:Male; D008568:Memory / Q000502:physiology; D009043:Motor Activity / Q000502:physiology; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012720:Severity of Illness Index