Watanabe Junko, Ogata Toshiyasu, Higashi Toshio, Inoue Tooru
Department of Rehabilitation, Fukuoka University Hospital, Fukuoka University, Fukuoka 814-0180, Japan; Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka University Hospital, Fukuoka 814-0180, Japan.
Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka University Hospital, Fukuoka 814-0180, Japan.
J Stroke Cerebrovasc Dis. 2017 Jun;26(6):1297-1305. doi: 10.1016/j.jstrokecerebrovasdis.2017.01.024. Epub 2017 Feb 22.
Whether improvement of cognitive function can be maintained remains controversial.
This study aimed to investigate cognitive changes between before carotid endarterectomy (CEA) or carotid artery stenting (CAS) and 1 year after intervention using cognitive evaluation tools.
Patients suspected as having carotid stenosis were prospectively registered for evaluation of cognitive function from October 2011 to December 2013 in the Department of Neurosurgery, Fukuoka University Hospital. Cognitive evaluation by the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were performed before and 1 year after CEA or CAS. Cognitive changes were evaluated using the Wilcoxon signed rank test, whereas the subscores of MoCA and MMSE were also compared.
The MoCA score was significantly ameliorated from 21 to 23 at 1 year after CEA (P = .003), but the MMSE score did not significantly change (24 to 25, P = .56). Additionally, the MoCA score was improved 1 year after CAS (P = .04), but it was unchanged in those who were treated medically (P = .15). Regarding the analyses of subscores, patients who had CEA improved in the areas of executive and memory functions, whereas those with medical treatment only showed improvement in memory. CAS did not improve any subscores. There was no significant improvement in the subscores of the MMSE in patients with CEA, CAS, or medical treatment 1 year after treatment compared with before treatment.
CEA or CAS may be significantly associated with cognitive improvement as evaluated by the MoCA. However, patients treated medically do not show improvement in cognitive performance.
认知功能的改善能否得以维持仍存在争议。
本研究旨在使用认知评估工具调查颈动脉内膜切除术（CEA）或颈动脉支架置入术（CAS）术前与术后1年之间的认知变化。
2011年10月至2013年12月，福冈大学医院神经外科对疑似患有颈动脉狭窄的患者进行前瞻性登记，以评估其认知功能。在CEA或CAS术前及术后1年，采用蒙特利尔认知评估量表（MoCA）和简易精神状态检查表（MMSE）进行认知评估。使用Wilcoxon符号秩检验评估认知变化，同时比较MoCA和MMSE的各子量表得分。
CEA术后1年，MoCA评分从21显著提高至23（P = 0.003），但MMSE评分无显著变化（从24至25，P = 0.56）。此外，CAS术后1年MoCA评分有所改善（P = 0.04），但接受药物治疗的患者MoCA评分未改变（P = 0.15）。关于子量表分析，接受CEA治疗的患者在执行功能和记忆功能方面有所改善，而仅接受药物治疗的患者仅在记忆方面有所改善。CAS未改善任何子量表得分。与治疗前相比，接受CEA、CAS或药物治疗的患者在治疗1年后MMSE子量表得分均无显著改善。
根据MoCA评估，CEA或CAS可能与认知改善显著相关。然而，接受药物治疗的患者认知表现未显示改善。
