Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Kristiina Relander; Marja Hietanen; Krista Nuotio; Petra Ijäs; Irene Tikkala; Eija Saimanen; Perttu J Lindsberg; Lauri Soinne

doi:10.3389/fneur.2020.593719

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Front Neurol. 2021 Jan 14:11:593719. doi: 10.3389/fneur.2020.593719. eCollection 2020.

Authors

Kristiina Relander^{1

2}, Marja Hietanen^{1

2}, Krista Nuotio^{2

3}, Petra Ijäs^{2

3}, Irene Tikkala^{1

2}, Eija Saimanen⁴, Perttu J Lindsberg^{2

3}, Lauri Soinne^{2

3}

Affiliations

¹ Neuropsychology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.
² Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.
³ Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.
⁴ Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland.

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.

Keywords: carotid endarterectomy; follow-up studies; mortality; postoperative cognitive dysfunction; survival.