title: The effect of white matter lesions on cognition after carotid revascularization.
abstract: BACKGROUND
  Cerebral white matter lesions (WML) are associated with cognitive impairment, and carotid revascularization with cognitive worsening or improvement. We assessed the relation between WML severity and changes in cognition after carotid endarterectomy or stenting.
  
  
  METHODS
  Patients with symptomatic carotid artery stenosis, enrolled in the International Carotid Stenting Study (ISRCTN25337470), underwent detailed neuropsychological examinations (NPEs) before and after 6 months. Cognitive results were standardized into z-scores, from which a sum score was calculated. The primary outcome was the mean difference (MD) in sum score between baseline and follow-up. Changes in sum score were related to WML severity with the 'age-related white matter changes' score, assessed on baseline MRI-FLAIR. Three groups were formed based on this score.
  
  
  RESULTS
  Eighty-nine patients had both baseline MRI and NPE, of these 77 had a calculable cognitive difference score. The cognitive sum score at six months was worse than at baseline: MD, -0.21; 95% CI, -0.32 to -0.09. The change in sum score did not depend on WML load: MD for no-to-mild WML, -0.15; 95% CI, -0.39 to 0.09, for moderate WML, -0.27; 95% CI, -0.48 to -0.06; and for severe WML, -0.21; 95% CI, -0.40 to -0.04. This did not change essentially after adjustment for baseline factors.
  
  
  CONCLUSIONS
  Cognitive functioning deteriorated after carotid revascularization, regardless of baseline WML burden.
authors.affiliation: Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, the Netherlands. Electronic address: a.altinbas@umcutrecht.nl.
authors.forename: Aysun
authors.initials: A
authors.lastname: Altinbas
authors.forename: Martine J E
authors.initials: MJ
authors.lastname: van Zandvoort
authors.forename: Esther
authors.initials: E
authors.lastname: van den Berg
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: de Borst
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hendrikse
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nederkoorn
authors.forename: Leo H
authors.initials: LH
authors.lastname: Bonati
authors.forename: Martin M
authors.initials: MM
authors.lastname: Brown
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: H Bart
authors.initials: HB
authors.lastname: van der Worp
mesh_terms: D001921:Brain / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000473:pathology* / Q000523:psychology* / Q000601:surgery; D003072:Cognition Disorders / Q000150:complications / Q000473:pathology* / Q000523:psychology* / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000523:psychology; D006801:Humans; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D059906:Neuroimaging; D009483:Neuropsychological Tests; D015607:Stents / Q000523:psychology
keywords: Angioplasty and stenting; Carotid artery disease; Carotid endarterectomy; Cognition; Follow-up; White matter disease