Relander Kristiina, Hietanen Marja, Ijäs Petra, Nuotio Krista, Vikatmaa Pirkka, Koskinen Suvi M, Ala-Kauhaluoma Marianne, Paajanen Teemu I, Virkkala Jussi, Lindsberg Perttu J, Soinne Lauri
Neuropsychology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Finland.
Neuropsychology, HUS Neurocenter, University of Helsinki and Helsinki University Hospital, Finland.
J Neurol Sci. 2024 Apr 15;459:122981. doi: 10.1016/j.jns.2024.122981. Epub 2024 Mar 28.
Carotid endarterectomy (CEA) has been associated with both cognitive decline and improvement, but the underlying neurovascular mechanisms are unclear. The aim of this study was to investigate the relationship between neurovascular indices and cognitive changes after CEA.
We studied 55 patients with severe (≥70%) symptomatic or asymptomatic carotid stenosis before and six months after CEA. A wide array of neuropsychological tests was arranged in eight cognitive domains and cognitive functions specific to hemisphere ipsilateral to operation. Differences in cognitive performance between patients and 38 matching healthy controls were studied with linear mixed models. Neurovascular functioning and microembolic signals were assessed with transcranial Doppler ultrasound of the middle cerebral artery. Associations between neurovascular indices and cognitive change were assessed with linear regression analyses.
On group level, the CEA patients improved more than controls in working memory, whereas no cognitive deterioration was detected. Also on individual level, improvement was most frequently observed in working memory. Worse preoperative cerebrovascular reactivity was related with improvement in cognitive functions of the ipsilateral hemisphere. Low preoperative pulsatility index was associated with improvement in executive functioning and ipsilateral cognitive functions. Poorer preoperative blood flow velocity associated with improvement in complex attention. Microembolic signals were rare.
The present findings suggest that CEA may have beneficial long-term effects on cognition. These effects may specifically involve patients with impaired preoperative circulatory adaptive mechanisms.
颈动脉内膜切除术（CEA）与认知功能减退和改善均有关联，但其潜在的神经血管机制尚不清楚。本研究的目的是探讨CEA术后神经血管指标与认知变化之间的关系。
我们对55例重度（≥70%）有症状或无症状颈动脉狭窄患者在CEA术前及术后6个月进行了研究。针对八个认知领域以及手术同侧半球特有的认知功能安排了一系列神经心理学测试。采用线性混合模型研究患者与38名匹配的健康对照者在认知表现上的差异。通过经颅多普勒超声评估大脑中动脉的神经血管功能和微栓子信号。采用线性回归分析评估神经血管指标与认知变化之间的关联。
在组水平上，CEA患者在工作记忆方面的改善超过了对照组，且未检测到认知功能恶化。在个体水平上，工作记忆方面最常观察到改善。术前脑血管反应性较差与同侧半球认知功能的改善有关。术前搏动指数较低与执行功能和同侧认知功能的改善有关。术前血流速度较差与复杂注意力的改善有关。微栓子信号很少见。
目前的研究结果表明，CEA可能对认知功能有长期有益影响。这些影响可能特别涉及术前循环适应机制受损的患者。
