Significant carotid stenosis is known to cause ischemic stroke and cognitive impairment.
However, it remains controversial whether carotid endarterectomy (CEA) can improve
cognitive function in patients with carotid stenosis. We used the Montreal Cognitive
Assessment (MoCA) and Mini-Mental State Examination (MMSE) to compare cognitive function
between before and after CEA. Patients were prospectively registered to evaluate cognitive
function from October 2011 to December 2012 after we determined them to have significant
carotid stenosis. Patients were examined by 3-dimensional computed tomographic angiography
or digital subtraction angiography. Although symptomatic cases were included, their
modified Rankin Scale was grade 0 or 1 before CEA. All CEA procedures were performed
by the same neurosurgical team. Cognitive function was evaluated by MoCA and MMSE
performed before and after surgery. Data were analyzed statistically using the Wilcoxon
signed rank test. Thirty-six patients were included in this study. The MoCA score
after surgery, whereas the MMSE score was not. After surgery, the MoCA score improved
in patients who were 73 years or younger, who underwent CEA in the left side of their
carotid lesion, who had severe carotid stenosis of more than 80%, who had bilateral
lesion, who did not have abnormal lesion on diffusion-weighted imaging after surgery,
or who had cerebral blood flow of pre-CEA over 34.5 mL. In conclusion, MoCA was feasible
in patients soon after undergoing CEA. Using MoCA not MMSE, CEA may improve cognitive
function in patients with significant carotid stenosis.
Key Words
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Article info
Publication history
Published online: January 24, 2014
Accepted:
November 7,
2013
Received in revised form:
September 27,
2013
Received:
July 27,
2013
Footnotes
This study was partly supported by the grant from Clinical Research Foundation in Japan.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.11.004
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
