title: Inflammation and cognitive dysfunction in type 2 diabetic carotid endarterectomy patients.
abstract: OBJECTIVE
  Type 2 diabetic patients have a high incidence of cerebrovascular disease, elevated inflammation, and high risk of developing cognitive dysfunction following carotid endarterectomy (CEA). To elucidate the relationship between inflammation and the risk of cognitive dysfunction in type 2 diabetic patients, we aim to determine whether elevated levels of systemic inflammatory markers are associated with cognitive dysfunction 1 day after CEA.
  
  
  METHODS
  One hundred fifteen type 2 diabetic CEA patients and 156 reference surgical patients were recruited with written informed consent in this single-center cohort study. All patients were evaluated with an extensive battery of neuropsychometric tests. Preoperative monocyte counts, HbA1c, C-reactive protein (CRP), intercellular adhesion molecule 1, and matrix metalloproteinase 9 activity levels were obtained.
  
  
  RESULTS
  In a multivariate logistic regression model constructed to identify predictors of cognitive dysfunction in type 2 diabetic CEA patients, each unit of monocyte counts (odds ratio [OR] 1.76 [95% CI 1.17-2.93]; P=0.005) and CRP (OR 1.17 [1.10-1.29]; P<0.001) was significantly associated with higher odds of developing cognitive dysfunction 1 day after CEA in type 2 diabetic patients.
  
  
  CONCLUSIONS
  Type 2 diabetic patients with elevated levels of preoperative systemic inflammatory markers exhibit more cognitive dysfunction 1 day after CEA. These observations have implications for the preoperative medical management of this high-risk group of surgical patients undergoing carotid revascularization with CEA.
authors.affiliation: Corresponding author: Eric J. Heyer, ejh3@columbia.edu.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Heyer
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Mergeche
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Bruce
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000097:blood / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005905:Glyburide / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007249:Inflammation / Q000097:blood / Q000209:etiology*; D016015:Logistic Models; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D011719:Pyrazines / Q000627:therapeutic use; D000068900:Sitagliptin Phosphate; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D007004:Hypoglycemic Agents; D011719:Pyrazines; D013453:Sulfonylurea Compounds; D014230:Triazoles; C057619:glimepiride; D008687:Metformin; D005905:Glyburide; D000068900:Sitagliptin Phosphate