Department of Neurological Sciences, University of Padua, School of Medicine, Padova, Italy.
Surgery. 2012 Jan;151(1):99-106. doi: 10.1016/j.surg.2011.06.031. Epub 2011 Sep 22.
Carotid endarterectomy (CEA) reduces the risk of stroke in selected patients with symptomatic and asymptomatic carotid disease, but its beneficial influence on cognitive performance in the elderly remains debatable. This prospective study sought to determine early and long-term neurocognitive outcomes after CEA for severe unilateral carotid artery stenosis.
From July 2006 to December 2008, 75 symptomatic (group A) and 70 asymptomatic patients (group B) aged 65 years and older underwent CEA under general anesthesia. Sixty-eight age- and sex-matched individuals who underwent laparoscopic cholecystectomy during the same period at our institution served as a control group (group H). Patients with contralateral severe carotid stenosis or occlusion and those with dementia, depression, or a history of major stroke were excluded. Cognitive function was assessed using 2 neuropsychological tests (the Mini-Mental State Examination [MMSE] and the Montreal Cognitive Assessment [MoCA]) performed preoperatively (T0) and then 3 (T1) and 12 months (T2) after operation. A change of at least 2 points between the scores at T0 and T2 was arbitrarily considered as clinically significant.
At T0, group A revealed significant cognitive impairments in both mean test scores by comparison with group H (P = .005 and P < .01, respectively), whereas there were no significant differences between groups A and B, or between groups B and H. Postoperatively, symptomatic patients had significant improvements in their mean cognitive performance scores in both tests (P < .01 and P < .01, respectively), whereas there were no changes in the asymptomatic and control patients' scores. No significant differences emerged for the MMSE scores in the 3 groups, whereas there was a marginally significant difference in the MoCA scores between groups A and H (P = .08), but not for A versus B or B versus H when clinically significant scores were considered.
Our study showed that only elderly symptomatic patients with severe carotid lesions had a significant improvement in cognitive performance scores after CEA, although the benefit was considered clinically not significant. This suggests that CEA does not diminish neurocognitive functions, but it might provide some protection against cognitive decline in the elderly.
颈动脉内膜切除术 (CEA) 可降低有症状和无症状颈动脉疾病患者发生中风的风险，但它对老年人认知功能的有益影响仍存在争议。本前瞻性研究旨在确定重度单侧颈动脉狭窄患者行 CEA 后的早期和长期神经认知结局。
2006 年 7 月至 2008 年 12 月，75 例有症状（A 组）和 70 例无症状（B 组）年龄在 65 岁及以上的患者在全身麻醉下接受 CEA。同期在我院行腹腔镜胆囊切除术的 68 例年龄和性别匹配的个体作为对照组（H 组）。排除对侧重度颈动脉狭窄或闭塞以及痴呆、抑郁或有重大中风史的患者。采用 2 种神经心理学测试（简易精神状态检查 [MMSE] 和蒙特利尔认知评估 [MoCA]）评估认知功能，分别于术前（T0）、术后 3 个月（T1）和 12 个月（T2）进行。将 T0 和 T2 之间评分的变化至少 2 分视为具有临床意义。
在 T0，与 H 组相比，A 组的平均测试评分均显示出显著的认知障碍（P =.005 和 P <.01），而 A 组和 B 组之间以及 B 组和 H 组之间无显著差异。手术后，有症状的患者在这两种测试中的平均认知表现评分均有显著提高（P <.01 和 P <.01），而无症状和对照组患者的评分没有变化。3 组的 MMSE 评分无显著差异，而 A 组和 H 组之间的 MoCA 评分有显著差异（P =.08），但当考虑到具有临床意义的评分时，A 组与 B 组或 B 组与 H 组之间无显著差异。
我们的研究表明，只有患有严重颈动脉病变的老年有症状患者在接受 CEA 后认知功能评分有显著提高，尽管这种益处被认为在临床上没有意义。这表明 CEA 不会降低神经认知功能，但它可能为老年人的认知能力下降提供一些保护。
