颈动脉内膜切除术对无症状颈动脉狭窄患者认知功能的影响。
Effect of carotid endarterectomy on cognitive function in patients with asymptomatic carotid artery stenosis.
机构信息
Department of Neurosurgery, Faculty of Medicine, University of Toyama, Sugitani 2630, Toyama, Toyama, 930-0194, Japan.
出版信息
Acta Neurochir (Wien). 2013 Apr;155(4):627-33. doi: 10.1007/s00701-013-1625-0. Epub 2013 Jan 30.
BACKGROUND
This study was conducted to determine if patients with asymptomatic carotid artery stenosis show cognitive function decline, and if they experience any changes in cognitive function after carotid endarterectomy (CEA).
METHOD
Cognitive function was examined in 15 patients (12 males and three females, 70.0 ± 6.5 years) with asymptomatic carotid artery stenosis before and 3 months after CEA. Cognitive function was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), two subtests of the Wechsler Adult Intelligence Scale-Revised (WAIS-R 2 subtests), and the Japanese version of National Adult Reading Test (JART). The patients' average scores were compared with the normal average by one-sample t-tests, and the before and after scores were compared with paired t-tests. Changes in each patient were calculated from difference before and after CEA using 95 % confidence intervals.
RESULTS
Before surgery, patients showed significant cognitive decline in RBANS total scale and immediate memory, language, and attention. At 3 months after CEA, the total scale and the immediate memory were not significantly different from the normal average. The average total scale score, the immediate memory and attention, and the WAIS-R 2 subtests scores were increased after treatment. Changes in each patient were calculated from the scores before and after CEA. At 3 months after CEA, the rate of increase in RBANS scores were 60.0 % of the patients for immediate memory, 26.7 % for visuospatial/constructional, 33.3 % for language and attention, 26.7 % for delayed memory, 47.7 % for total scale and 26.7 % for WAIS-R 2 subtests. Thus, so-called asymptomatic patients exhibit mild cognitive impairment before surgery, but after CEA, patients recover normal memory abilities.
CONCLUSIONS
Our findings of mild cognitive dysfunction in asymptomatic patients suggest that they might be symptomatic after all.
背景
本研究旨在确定无症状颈动脉狭窄患者是否存在认知功能下降，以及颈动脉内膜切除术（CEA）后认知功能是否发生变化。
方法
对 15 例无症状颈动脉狭窄患者（男 12 例，女 3 例，70.0±6.5 岁）在 CEA 前后进行认知功能检查。采用重复认知评估量表（RBANS）、韦氏成人智力量表修订版（WAIS-R）2 个分量表和日本成人阅读测验（JART）评估认知功能。采用单样本 t 检验比较患者平均得分与正常平均得分的差异，采用配对 t 检验比较 CEA 前后的得分。采用 95%置信区间计算每位患者 CEA 前后差值的变化。
结果
手术前，患者在 RBANS 总分和即刻记忆、语言和注意力方面表现出显著的认知下降。CEA 后 3 个月，总分和即刻记忆与正常平均值无显著差异。治疗后，WAIS-R 2 分量表和即刻记忆、注意力、总分平均分升高。从 CEA 前后的评分计算每位患者的变化。CEA 后 3 个月，RBANS 即刻记忆评分增加的患者比例为 60.0%，视空间/结构的为 26.7%，语言和注意力的为 33.3%，延迟记忆的为 26.7%，总分的为 47.7%，WAIS-R 2 分量表的为 26.7%。因此，所谓的无症状患者在手术前存在轻度认知障碍，但 CEA 后，患者恢复了正常的记忆能力。
结论
我们发现无症状患者存在轻度认知功能障碍，提示他们可能存在症状。
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