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Easily Screenable Characteristics Associated with Cognitive Improvement and Dysfunction After Carotid Endarterectomy
- Source :
- World neurosurgery. 121
- Publication Year :
- 2018
-
Abstract
- Background Carotid endarterectomy (CEA) is an effective treatment for the prevention of stroke in patients with carotid artery stenosis. We aimed to clarify the incidence and risk factors for early cognitive dysfunction (eCD) and early cognitive improvement (eCI), defined as change in cognitive performance ≤24 hours after surgery, using a battery of neuropsychometric tests. Methods In total, 585 patients undergoing CEA were tested with neuropsychometric tests before and after surgery; 155 patients undergoing “simple” spine surgery were the reference group. Patient performance for each test was evaluated by z scores. Cognitive change was defined as eCD (or eCI) if: 1) patients had a z score ≤–2 (or ≥2) in ≥2 cognitive domains or 2) patients had mean z scores across all domains ≤–1.5 (or ≥1.5). Associations between the categorical cognitive outcomes and variables of interest were modeled using the proportional odds model. Results Of the 585 subjects, 24% had eCD, 6% had eCI, and 70% had “no change.” Patients who had eCD were more likely to be statin naive (odds ratio [OR] 1.23 [1.03–1.48], P = 0.02) or women (OR 1.27 [1.06–1.53], P = 0.02). Those with eCI were less likely to have less formal education (OR 0.95 [0.90–1.00], P = 0.04) and less likely to have diabetes mellitus (OR 0.8 [0.65–0.99], P = 0.04). Conclusions Patients having CEA may develop eCD or eCI postoperatively. Medications likely to be associated with less eCD are statins and aspirin, which correlate most strongly in asymptomatic patients. In addition to confirming previous findings, we found that women were more likely than men to develop eCD. More sex-specific studies and analysis are needed to better explore these findings.
- Subjects :
- Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Carotid endarterectomy
Neuropsychological Tests
Asymptomatic
Article
03 medical and health sciences
0302 clinical medicine
Diabetes mellitus
Internal medicine
medicine
Humans
Carotid Stenosis
Effects of sleep deprivation on cognitive performance
Prospective Studies
Stroke
Aged
Retrospective Studies
Aged, 80 and over
Postoperative Care
Aspirin
Endarterectomy, Carotid
business.industry
Incidence (epidemiology)
Odds ratio
Middle Aged
medicine.disease
Early Diagnosis
Treatment Outcome
030220 oncology & carcinogenesis
Surgery
Female
Neurology (clinical)
medicine.symptom
business
Cognition Disorders
030217 neurology & neurosurgery
medicine.drug
Subjects
Details
- ISSN :
- 18788769
- Volume :
- 121
- Database :
- OpenAIRE
- Journal :
- World neurosurgery
- Accession number :
- edsair.doi.dedup.....5f68781c51d6e48cd5bfd57c8d87537d