title: Age-dependent effects of carotid endarterectomy or stenting on cognitive performance.
abstract: Although evidence is accumulating that age modifies the risk of carotid angioplasty and stenting (CAS) versus endarterectomy (CEA) for patients with significant carotid stenosis, the impact of age on cognition after either CEA or CAS remains unclear. In this study, we analyzed the effects of age on cognitive performance after either CEA or CAS using a comprehensive neuropsychological test battery with parallel test forms and a control group to exclude a learning effect. The neuropsychological outcomes after revascularization were determined in 19 CAS and 27 CEA patients with severe carotid stenosis. The patients were subdivided according to their median age (<68 years and ≥68 years); 27 healthy subjects served as a control group. In all patients clinical examinations, MRI scans and a neuropsychological test battery that assessed four major cognitive domains were performed immediately before, within 72 h, and 3 months after CEA or CAS. While patients <68 years of age showed no significant cognitive alteration after either CEA or CAS, a significant cognitive decline was observed in patients ≥68 years in both treatment groups (p = 0.001). Notably, this cognitive deterioration persisted in patients after CEA, whereas it was only transient in patients treated with CAS. These results demonstrate an age-dependent effect of CEA and CAS on cognitive functions. In contrast to the recently observed increased clinical complication rates in older subjects after CAS compared with CEA, CEA appears to be associated with a greater, persistent decline in cognitive performance than CAS in this subgroup of patients.
authors.affiliation: Department of Neurology, University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. k.wasser@med.uni-goettingen.de
authors.forename: Katrin
authors.initials: K
authors.lastname: Wasser
authors.forename: Helmut
authors.initials: H
authors.lastname: Hildebrandt
authors.forename: Sonja
authors.initials: S
authors.lastname: Gröschel
authors.forename: Tomislav
authors.initials: T
authors.lastname: Stojanovic
authors.forename: Holger
authors.initials: H
authors.lastname: Schmidt
authors.forename: Klaus
authors.initials: K
authors.lastname: Gröschel
authors.forename: Sara M
authors.initials: SM
authors.lastname: Pilgram-Pastor
authors.forename: Michael
authors.initials: M
authors.lastname: Knauth
authors.forename: Andreas
authors.initials: A
authors.lastname: Kastrup
mesh_terms: D000367:Age Factors; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000523:psychology; D016893:Carotid Stenosis / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery*; D003072:Cognition Disorders / Q000453:epidemiology / Q000523:psychology*; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome