Department of Surgery, Division of Vascular Surgery, The University of Arizona, Tucson, AZ.
Department of Psychiatry, The University of Arizona, Tucson, AZ.
Surgery. 2023 Oct;174(4):1078-1082. doi: 10.1016/j.surg.2023.07.010. Epub 2023 Aug 6.
Cognitive impairment is the epitome of cerebrovascular diseases, causing a significant economic burden on our health care system. Growing evidence has indicated the benefits of carotid interventions in patients with severe carotid atherosclerosis. However, the neurocognitive outcome of carotid revascularization in octogenarians is not clearly understood. We aim to evaluate postintervention cognitive changes in seniors older than 80 years.
We prospectively recruited 170 patients undergoing carotid interventions. Neurocognitive testing was performed preoperatively and at 1, 6, and 12 months postoperatively. Episodic memory was assessed with Rey's Auditory Verbal Learning Test. Other executive functions and language measures were also evaluated at individual time points. Raw test scores were converted to z-scores or scaled scores adjusted for age and education. The sample was divided into 2 groups based on age: octogenarian (≥80 years) and nonoctogenarian (<80 years old). Postoperative cognitive scores were compared to baseline within each subcohort.
A total of 23 subjects (13%) were octogenarians, and 147 (87%) were younger than 80 years. Younger patients demonstrated significant cognitive improvements up to 12 months postop compared to the baseline. However, octogenarians exhibited a lack of improvement in verbal memory, measures of executive function, and language at all 3 postintervention time points.
Carotid interventions improve cognitive functions in younger patients with carotid occlusive atherosclerosis. However, no cognitive benefits were seen in male seniors older than 80 years. Further investigations are warranted to better understand the postinterventional cognitive changes in octogenarians.
认知障碍是脑血管疾病的典型表现，给我们的医疗体系带来了巨大的经济负担。越来越多的证据表明颈动脉介入治疗在严重颈动脉粥样硬化患者中的益处。然而，80 岁以上患者颈动脉血运重建的神经认知结果尚不清楚。我们旨在评估 80 岁以上老年人术后的认知变化。
我们前瞻性招募了 170 例接受颈动脉介入治疗的患者。神经认知测试在术前和术后 1、6 和 12 个月进行。采用 Rey 听觉言语学习测试评估情景记忆。在各个时间点还评估了其他执行功能和语言测量。原始测试分数转换为 z 分数或经年龄和教育调整的量表分数。根据年龄将样本分为 2 组：80 岁及以上（≥80 岁）和<80 岁。在每个亚组内，将术后认知评分与基线进行比较。
共有 23 名患者（13%）为 80 岁及以上，147 名患者（87%）年龄<80 岁。年轻患者与基线相比，术后 12 个月认知功能显著改善。然而，80 岁及以上患者在所有 3 个术后时间点在言语记忆、执行功能和语言测量方面均未表现出改善。
颈动脉介入治疗可改善有颈动脉闭塞性动脉粥样硬化的年轻患者的认知功能。然而，80 岁以上男性老年人没有观察到认知获益。需要进一步研究以更好地理解 80 岁以上老年人的术后认知变化。
