Cognitive Dysfunction and Mortality After Carotid Endarterectomy

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dc.contributor.author Relander, Kristiina
dc.contributor.author Hietanen, Marja
dc.contributor.author Nuotio, Krista
dc.contributor.author Ijäs, Petra
dc.contributor.author Tikkala, Irene
dc.contributor.author Saimanen, Eija
dc.contributor.author Lindsberg, Perttu J.
dc.contributor.author Soinne, Lauri
dc.date.accessioned 2021-03-16T07:44:00Z
dc.date.available 2021-03-16T07:44:00Z
dc.date.issued 2021-01-14
dc.identifier.citation 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
dc.identifier.other PURE: 161261068
dc.identifier.other PURE UUID: a5bb67b1-14a4-483b-bbf5-459b72a9d796
dc.identifier.other WOS: 000612319900001
dc.identifier.other ORCID: /0000-0001-7690-811X/work/90906346
dc.identifier.other ORCID: /0000-0003-4588-050X/work/90906656
dc.identifier.other ORCID: /0000-0002-7292-1971/work/90907336
dc.identifier.uri http://hdl.handle.net/10138/328045
dc.description.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. en
dc.format.extent 9
dc.language.iso eng
dc.relation.ispartof Frontiers in neurology
dc.rights cc_by
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject carotid endarterectomy
dc.subject postoperative cognitive dysfunction
dc.subject mortality
dc.subject survival
dc.subject follow-up studies
dc.subject A-BETA
dc.subject IMPROVEMENT
dc.subject IMPAIRMENT
dc.subject PREDICTS
dc.subject DISEASE
dc.subject SURGERY
dc.subject RATIO
dc.subject 3112 Neurosciences
dc.subject 3124 Neurology and psychiatry
dc.title Cognitive Dysfunction and Mortality After Carotid Endarterectomy en
dc.type Article
dc.contributor.organization Clinicum
dc.contributor.organization HUS Neurocenter
dc.contributor.organization Helsinki University Hospital Area
dc.contributor.organization Department of Neurosciences
dc.contributor.organization University of Helsinki
dc.contributor.organization Research Programs Unit
dc.contributor.organization Perttu Lindsberg / Principal Investigator
dc.contributor.organization Neurologian yksikkö
dc.contributor.organization South Carelia Social and Health care District Eksote
dc.description.reviewstatus Peer reviewed
dc.relation.doi https://doi.org/10.3389/fneur.2020.593719
dc.relation.issn 1664-2295
dc.rights.accesslevel openAccess
dc.type.version publishedVersion

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