Abstract

Aim: To analyze age-associated cognitive impact of carotid endarterectomy (CEA) in asymptomatic patients diagnosed with severe carotid disease. Our previous research showed that such patients often have subtle cognitive abnormalities detectable by Montreal Cognitive Assessment (MoCA).

Methods: Baseline cognitive status 1-2 months before CEA and cognitive follow-up using MoCA was done in 47 patients 6-12 months after CEA and associations between total cognitive change presented as differences in total MoCA score were examined. Patients were classified as cognitively impaired at MoCA score ≤ 26. Z test was used to test differences in proportions of cognitively impaired and normal participants in four age groups. Cognitive results for four age groups were examined and adjusted for baseline cognitive scores, age, gender and vascular risk factors.

Results: Differences in total MoCA scores were significant in patients 60-69 years of age (p<0.05). Following CEA, proportions of cognitively impaired participants were significantly decreased in younger participants (from 45-59, 60-69 and 70-79 years). Variables associated with increased cognitive decline after CEA were older age (OR 0.71, CI 0.612-0.902), hypertension (OR 3.87, CI 0.734-27.332) and ever smoking (OR 3,94, CI 0.759-29.164).

Conclusion: Positive cognitive impact of CEA is not present in older patients. Besides older age, arterial hypertension and ever smoking seem to be additional factors negatively influencing the cognitive benefit of CEA.

Keywords: Cognitive impairment; Carotid stenosis; Carotid endarterectomy; Aging