title: Cognitive improvement in patients with carotid stenosis is independent of treatment type.
abstract: Treatment of carotid artery stenosis decreases the long-term risk of stroke and may enhance cerebral blood flow. It is therefore expected to have the potential to prevent cognitive decline or even improve cognition over the long-term. However, intervention itself can cause peri-interventional cerebral infarcts, possibly resulting in a decline of cognitive performance, at least for a short time. We investigated the long-term effects of three treatment methods on cognition and the emotional state one year after intervention. In this prospective observational cohort study, 58 patients with extracranial carotid artery stenosis (≥ 70%) underwent magnetic resonance imaging and assessment of cognition, mood and motor speed before carotid endarterectomy (n = 20), carotid stenting (n = 10) or best medical treatment (n = 28) (i.e., time-point 1 [TP1]), and at one-year follow-up (TP2). Gain scores, reflecting cognitive change after treatment, were built according to performance as (TP2 -TP1)/TP1. Independent of the treatment type, significant improvement in frontal lobe functions, visual memory and motor speed was found. Performance level, motor speed and mood at TP1 were negatively correlated with gain scores, with greater improvement in patients with low performance before treatment. Active therapy, whether conservative or interventional, produces significant improvement of frontal lobe functions and memory in patients with carotid artery disease, independent of treatment type. This effect was particularly pronounced in patients with low cognitive performance prior to treatment.
authors.affiliation: Support Centre for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, Bern, Switzerland; Centre for Cognition, Learning and Memory, University of Bern, Switzerland.
authors.forename: Manuela
authors.initials: M
authors.lastname: Wapp
authors.affiliation: Support Centre for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, Bern, Switzerland; Centre for Cognition, Learning and Memory, University of Bern, Switzerland; Division of Neuropa.
authors.forename: Regula
authors.initials: R
authors.lastname: Everts
authors.affiliation: Support Centre for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, Bern, Switzerland; Department of Psychiatric Neurophysiology, University Hospital of Psychiatry, University of Ber.
authors.forename: Yuliya
authors.initials: Y
authors.lastname: Burren
authors.affiliation: Support Centre for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, Bern, Switzerland.
authors.forename: Frauke
authors.initials: F
authors.lastname: Kellner-Weldon
authors.affiliation: Support Centre for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, Bern, Switzerland.
authors.forename: Marwan
authors.initials: M
authors.lastname: El-Koussy
authors.affiliation: Support Centre for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, Bern, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Wiest
authors.affiliation: Department of Psychiatric Neurophysiology, University Hospital of Psychiatry, University of Bern, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Federspiel
authors.affiliation: Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
authors.affiliation: Support Centre for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, Bern, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000523:psychology* / Q000628:therapy*; D003071:Cognition / Q000502:physiology*; D004644:Emotions; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D015607:Stents / Q000009:adverse effects*; D013557:Switzerland; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome