Keywords
Cognition
Cerebral blood flow
Cerebral metabolism
Small vessel diseases
Submitted : 2024-03-17
Accepted : 2024-04-01
Published : 2024-04-16
Abstract
To develop a clinically meaningful definition of cognitive change before and after carotid endarterectomy (CEA), we categorized patients with “improved postoperative function” and “non-improved postoperative function” based on subjective assessment and neuropsychological tests. The results showed that 11% of the patients showed an improvement in postoperative function. Through single-photon emission computerized tomography (SPECT), positron emission tomography (PET), magnetic resonance imaging (MRI), etc., it was found that improvement of cerebral blood flow by carcinoembryonic antigen (CEA) → improvement of cerebral metabolism → improvement of cerebral cortical neuroreceptor function and cerebral white matter microstructure → improvement of cognitive function. The degree of preoperative cerebral hemispheric white matter lesions was the rate-limiting factor for improvement in cognitive function.
References
Yoshida K, Ogasawara K, Kobayashi M, et al., 2012, Improvement and Impairment in Cognitive Function After Carotid Endarterectomy: Comparison of Objective and Subjective Assessments. Neurol Med Chir (Tokyo), 52(3): 154–160.
Aharon-Peretz J, Tomer R, Gabrieli I, et al., 2003, Cognitive Performance Following Endarterectomy in Asymptomatic Severe Carotid Stenosis. Eur J Neurol 10(5): 525–528.
De Rango P, Caso V, Leys D, et al., 2008, The Role of Carotid Artery Stenting and Carotid Endarterectomy in Cognitive Performance: A Systematic Review. Stroke, 39(11): 3116–3127.
Iddon JL, Sahakian BJ, Kirkpatrick PJ, 1997, Pharmacol Biochem Behav Uncomplicated Carotid Endarterectomy is not Associated with Neuropsychological Impairment, 56(4): 781–787.
Irvine CD, Gardner FV, Davies AH, et al., 1998, Cognitive Testing in Patients Undergoing Carotid Endarterectomy. Eur J Vasc Endovasc Surg, 15(3): 195–204.
Lunn S, Crawley F, Harrison MJ, et al.,1999, Impact of Carotid Endarterectomy Upon Cognitive Functioning: A Systematic Review of the Literature. Cerebrovasc Dis, 9(2):74–81.
Rao R, 2001, The Role of Carotid Stenosis in Vascular Cognitive Impairment. Eur Neurol 46(2): 63–69.
Sinforiani E, Curci R, Fancellu R, et al., 2001, Neuropsychological Changes After Carotid Endarterectomy. Funct Neurol 16(4): 329–336.
Takahashi Y, Ogasawara K, Matsumoto Y, et al., 2013, Changes in Cognitive Function After Carotid Endarterectomy in Older Patients: Comparison with Younger Patients. Neurol Med Chir (Tokyo), 53(6): 353–359.
Chida K, Ogasawara K, Aso K, et al., 2010, Postcarotid Endarterectomy Improvement in Cognition is Associated with Resolution of Crossed Cerebellar Hypoperfusion and Increase in 123I-iomazenil Uptake in the Cerebral Cortex: a SPECT Study. Cerebrovasc Dis, 29(4): 343–351.
Kojima D, Ogasawara K, Kobayashi M, et al., 2016, Effects of Uncomplicated Carotid Endarterectomy on Cognitive Function and Brain Perfusion in Patients with Unilateral Asymptomatic Severe Stenosis of the Internal Carotid Artery by Comparison with Unoperated Patients. Neurol Res 38(7): 580–586.
Saito H, Ogasawara K, Nishimoto H, et al., 2013, Postoperative Changes in Cerebral Metabolites Associated with Cognitive Improvement and Impairment After Carotid Endarterectomy: A 3T Proton MR Spectroscopy Study. AJNR Am J Neuroradiol, 34(5): 976–982.
Yoshida K, Ogasawara K, Saura H, et al., 2015, Post-Carotid Endarterectomy Changes in Cerebral Glucose Metabolism on (18)F-Fluorodeoxyglucose Positron Emission Tomography Associated with Postoperative Improvement or Impairment in Cognitive Function. J Neurosurg 123(6): 1546–1554.
Shimada Y, Kobayashi M, Yoshida K, et al., 2019, Reduced Hypoxic Tissue and Cognitive Improvement after Revascularization Surgery for Chronic Cerebral Ischemia. Cerebrovasc Dis, 47(1–2): 57–64.
Ando T, Shimada Y, Fujiwara S, et al., 2020, Revascularisation Surgery Improves Cognition in Adult Patients with Moyamoya Disease. J Neurol Neurosurg Psychiatry 91(3): 332–334.
Sato Y, Ito K, Ogasawara K, et al., 2013, Postoperative Increase in Cerebral White Matter Fractional Anisotropy on Diffusion Tensor Magnetic Resonance Imaging is Associated with Cognitive Improvement After Uncomplicated Carotid Endarterectomy: Tract-Based Spatial Statistics Analysis. Neurosurgery 73(4): 592–599.
Yoshida J, Yamashita F, Sasaki M, et al., 2020, Adverse Effects of Pre-Existing Cerebral Small Vessel Disease on Cognitive Improvement After Carotid Endarterectomy. Int J Stroke 15(6): 657–665.
Krenk L, Rasmussen LS, Siersma VD, et al., 2012, Short-term Practice Effects and Variability in Cognitive Testing in a Healthy Elderly Population. Exp Gerontol 47(6): 432–436.