Cognitive Dysfunction and Mortality After Carotid Endarterectomy

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Relander , K , Hietanen , M , Nuotio , K , Ijäs , P , Tikkala , I , Saimanen , E , Lindsberg , P J & Soinne , L 2021 , ' Cognitive Dysfunction and Mortality After Carotid Endarterectomy ' , Frontiers in neurology , vol. 11 , 593719 . https://doi.org/10.3389/fneur.2020.593719

Title: Cognitive Dysfunction and Mortality After Carotid Endarterectomy
Author: Relander, Kristiina; Hietanen, Marja; Nuotio, Krista; Ijäs, Petra; Tikkala, Irene; Saimanen, Eija; Lindsberg, Perttu J.; Soinne, Lauri
Contributor: University of Helsinki, Clinicum
University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Neurocenter
University of Helsinki, South Carelia Social and Health care District Eksote
University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Neurocenter
Date: 2021-01-14
Language: eng
Number of pages: 9
Belongs to series: Frontiers in neurology
ISSN: 1664-2295
URI: http://hdl.handle.net/10138/328045
Abstract: Background: Carotid endarterectomy (CEA) has been associated with both postoperative cognitive dysfunction (POCD) and improvement (POCI). However, the prognostic significance of postoperative cognitive changes related to CEA is largely unknown. The aim of this study was to examine the associations between postoperative cognitive changes after CEA and long-term survival. Methods: We studied 43 patients 1 day before CEA as well as 4 days and 3 months after surgery with an extensive neuropsychological test array, and followed them for up to 14 years. POCD and POCI relative to baseline were determined with the reliable change index derived from 17 healthy controls. Associations between POCD/POCI and mortality within the patient group were studied with Cox regression analyses adjusted for confounders. Results: POCD in any functional domain was evident in 28% of patients 4 days after surgery and in 33% of patients 3 months after surgery. POCI was shown in 23% of patients at 4 days and in 44% of patients at 3 months. POCD at 3 months was associated with higher long-term mortality (hazard ratio 5.0, 95% CI 1.8-13.9, p = 0.002) compared with patients with no cognitive decline. Conclusions: Our findings suggest that POCD in a stable phase, 3 months after CEA predicts premature death. Evaluation of postoperative cognitive changes is essential, and POCD in a stable phase after CEA should prompt scrutiny of underlying factors and better adherence to therapies to prevent recurrences and to promote early intervention in imminent deterioration.
Subject: carotid endarterectomy
postoperative cognitive dysfunction
mortality
survival
follow-up studies
A-BETA
IMPROVEMENT
IMPAIRMENT
PREDICTS
DISEASE
SURGERY
RATIO
3112 Neurosciences
3124 Neurology and psychiatry
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