Miyamatsu Yuichiro, Nakamizo Akira, Amano Toshiyuki, Matsuo Satoshi, Kuwashiro Takahiro, Yasaka Masahiro, Okada Yasushi, Mizoguchi Masahiro, Yoshimoto Koji
Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, JPN.
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JPN.
Cureus. 2022 Jul 3;14(7):e26534. doi: 10.7759/cureus.26534. eCollection 2022 Jul.
Patients with carotid stenosis risk cognitive impairment even after carotid endarterectomy (CEA) because of the long-term presence of vascular risk factors. Early prediction of cognitive decline is useful because early appropriate training for impaired cognitive domains can improve their functions. Ankle-brachial index (ABI) and cardio-ankle vascular index (CAVI) are frequently used as general indicators of systemic atherosclerosis and are associated with cognitive function in the general population. This study aimed to evaluate the utility of those vascular biomarkers for predicting cognitive decline in patients after CEA.
Patients who had undergone both CEA at our institute and cognitive evaluations between March 2016 and January 2022 were invited to participate in this study. Associations between ABI or CAVI three years before baseline and cognitive function at baseline were assessed retrospectively in 94 patients, and associations between ABI or CAVI at baseline and three-year changes in cognitive functions were assessed prospectively in 24 patients. Cognitive functions were assessed using the Frontal Assessment Battery (FAB) and Neurobehavioral Cognitive Status Examination (Cognistat).
Low ABI three years before baseline was associated with poor performances on Cognistat and FAB at baseline. ABI, as a continuous measure, three years before baseline, showed positive linear associations with total Cognistat score and subscores for naming, construction, and judgment at baseline. The Wilcoxon signed-rank test showed that the total Cognistat score, total FAB score, and subscores for attention and inhibitory control declined after three years. CAVI at baseline was negatively associated with three-year changes in total Cognistat score and subscores for naming, construction, and memory.
Cognitive function can decline over time in patients with carotid stenosis even after CEA. ABI and CAVI might be useful to predict cognitive function and its decline among patients who have undergone CEA.
由于长期存在血管危险因素，颈动脉狭窄患者即使在接受颈动脉内膜切除术（CEA）后仍有认知功能障碍的风险。认知功能下降的早期预测很有用，因为对受损认知领域进行早期适当训练可以改善其功能。踝臂指数（ABI）和心踝血管指数（CAVI）经常被用作全身动脉粥样硬化的一般指标，并且与普通人群的认知功能相关。本研究旨在评估这些血管生物标志物在预测CEA术后患者认知功能下降方面的效用。
邀请2016年3月至2022年1月在我院接受过CEA和认知评估的患者参加本研究。回顾性评估94例患者基线前三年的ABI或CAVI与基线时认知功能之间的关联，并前瞻性评估24例患者基线时的ABI或CAVI与认知功能三年变化之间的关联。使用额叶评估量表（FAB）和神经行为认知状态检查（Cognistat）评估认知功能。
基线前三年低ABI与基线时Cognistat和FAB表现不佳相关。基线前三年作为连续测量指标的ABI与基线时Cognistat总分以及命名、构图和判断子分数呈正线性相关。Wilcoxon符号秩检验显示，三年后Cognistat总分、FAB总分以及注意力和抑制控制子分数下降。基线时的CAVI与Cognistat总分以及命名、构图和记忆子分数的三年变化呈负相关。
即使在CEA术后，颈动脉狭窄患者的认知功能也可能随时间下降。ABI和CAVI可能有助于预测接受CEA患者的认知功能及其下降情况。
