Abstract
Background
Cerebral white matter lesions (WML) are associated with cognitive impairment, and
carotid revascularization with cognitive worsening or improvement. We assessed the
relation between WML severity and changes in cognition after carotid endarterectomy
or stenting.
Methods
Patients with symptomatic carotid artery stenosis, enrolled in the International Carotid
Stenting Study (ISRCTN25337470), underwent detailed neuropsychological examinations
(NPEs) before and after 6 months. Cognitive results were standardized into z-scores, from which a sum score
was calculated. The primary outcome was the mean difference (MD) in sum score between
baseline and follow-up. Changes in sum score were related to WML severity with the
‘age-related white matter changes’ score, assessed on baseline MRI-FLAIR. Three groups
were formed based on this score.
Results
Eighty-nine patients had both baseline MRI and NPE, of these 77 had a calculable cognitive
difference score. The cognitive sum score at six months was worse than at baseline:
MD, −0.21; 95% CI, −0.32 to −0.09. The change in sum score did not depend on WML load: MD for no-to-mild WML, −0.15; 95% CI, −0.39 to 0.09, for moderate WML, −0.27; 95% CI, −0.48 to −0.06; and for severe WML, −0.21; 95% CI, −0.40 to −0.04. This did not change essentially after adjustment for baseline factors.
Conclusion
Cognitive functioning deteriorated after carotid revascularization, regardless of
baseline WML burden.
Keywords
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Article info
Publication history
Published online: August 30, 2013
Accepted:
July 25,
2013
Received in revised form:
June 21,
2013
Received:
May 4,
2013
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
