IMPACT OF CAROTID ENDARTERECTOMY ON COGNITIVE PERFORMANCE AND DEPRESSIVE SYMPTOMS

Elina Pucite; Marius Slisers; Evija Miglane; Dainis Krievins; Renars Erts; Kristaps Jurjans; Ildze Krievina

doi:10.12955/cbup.v4.820

Elina Pucite Pauls Stradins Clinical University Hospital
Marius Slisers University of Latvia
Evija Miglane Pauls Stradins Clinical University Hospital
Dainis Krievins Pauls Stradins Clinical University Hospital
Renars Erts Pauls Stradins Clinical University Hospital
Kristaps Jurjans Pauls Stradins Clinical University Hospital
Ildze Krievina Pauls Stradins Clinical University Hospital

DOI: https://doi.org/10.12955/cbup.v4.820

Keywords: carotid endarterectomy, cognitive impairment, depressive symptoms

Abstract

OBJECTIVES: This study aims to evaluate the impact of carotid endarterectomy (CEA) on cognitive performance in patients with severe carotid disease and depressive symptoms, and to explore the possible associations between certain demographics, clinical characteristics, and cognitive function and depression.

MATERIALS AND METHODS: The study included 48 patients, who were referred for endarterectomy. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) scale, while depressive symptoms were assessed using the patient health questionnaire(PHQ-9) scale. An assessment of cognitive and depressive symptoms was performed 1–3 days before surgery, and then six months after.

RESULTS: A paired sample t-test found that the difference in the mean MoCA score between the before (=23.37; SD ± 3.27) and the after (=24.69; SD ± 3.68) surgery results was 1.32 (95% CI = 0.48 – 2.16; p= 0.003; Cohen’s d value = 0.95). A paired sample t-test showed that a decrease in mean PHQ-9 score of > 10 for patients six months after CEA (7.5±4.6) was statistically significant (p= 0.019; Cohen’s d value = 1.32) compared with the PHQ-9 scores at baseline (12.6 ± 2.8).

CONCLUSION: Carotid artery endarterectomy seems to have beneficial effects on the course of cognitive impairment and depressive symptoms in patients with severe carotid artery stenosis. Demographic, clinical characteristics (age, gender, comorbidities, previous stroke) did not have impact on course of cognitive and depressive symptoms. A limitation in our study was that the number of patients was relatively small, therefore we intend to perform further study with larger case volume to estimate the impact of carotid artery endarterectomy on cognitive functions and depressive symptoms.

References

Alexopoulos, G. S., Meyers, B. S., Young, R. C., Campbell, S., Silbersweig, D., & Charlston, M. (1997). “Vascular depression” hypothesis. Archives of General Psychiatry, 54, 915–922.

Aminoff (2009). Handbook of Clinical Neurology, Volume 94. Stroke Part III: Investigation and management. Amsterdam, Elsevier. 971 – 1327.

Baracchini, C., Mazzalai, F., Gruppo, M., Lorenzetti, R., Ermani, M., & Ballotta, E. (2012). Carotid endarterectomy protects elderly patients from cognitive decline: a prospective study. Surgery, 151, 99–106.

Barnett, H. J. M., Taylor, D. W., Eliasziw, M., Fox, A. J., Ferguson, G. G., Haynes, R. B., Rankin, R. N., Clagett, G. P., Hachinski, V. C., Sackett, D. L., Math, K. E. T. M., & Meldrum. H. E (1998). Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. New England Journal of Medicine, 339,1415-1425.

Crawley, F., Stygall, J., Lunn, S., Harrison, M., Brown, M. M., & Newman, S. (2000). Comparison of microembolism detected by transcranial Doppler and neuropsychological sequelae of carotid surgery and percutaneous transluminal angioplasty. Stroke, 31, 1329–1334.

Everts, R., Wapp, M., Burren, Y., Kellner-Weldon F., El-Koussy, M., Jann, K., Lenior, J. D., Michel, P., & Schroth, G. (2014). Cognitive and emotional effects of carotid stenosis. Swiss Medical Weekly, 144, w13970.

Faramawi, M. F., Gustat, J., Wildman, R. P., Rice, J., Johnson, E., & Sherwin, R. (2007). Relation between depressive symptoms and common carotid artery atherosclerosis in American persons ≥ 65 years of age. The American Journal of Cardiology, 1610-1613.

Gressier, F., Khlif, H., Denier, C., Hardy, P., Ducreux, D., & Corruble, E. (2011). Drug-resistant major depression associated with carotid artery stenosis. American Journal oF Psychiatry, 168, 4, 439.

Hachinski, V., Iadecola, C., Petersen, R. C., Breteler, M. M., Nyenhuis, D. L., Black, S. E., Powers, W. J., DeCarli, C., Merino, J. G., Kalaria, R. N., Vinters, H. V., Holtzman, D. M., Rosenberg, G. A., Wallin, A., Dichgans, M., Marler, J. R., & Leblanc, G. G. (2006). National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke, 37, 2220– 2241.

Hachinski, V. (2007). Stroke and vascular cognition impairment. A transdisciplinary, translational and transactional approach. Stroke, 38, 1396-1403.

Halliday, A., Mansfield, A., Marro, J., Peto, C., Peto, R., Potter, J., & Thomas, D. (2004). Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet 2004;363:1491-502.

Huang, H., Chen, K., Guo, T., Zhang, Y., Qu, W., Zhou, Z., Liu, G., & Chen, L. (2012). Treatment with carotid angioplasty stent placement for post-stroke depression compared to antidepressants. Neurosciences, 17(1), 53-56.

Jokinen, H., Kalska, H., Ylikoski, R., Madureira, S., Verdelho, A., van der Flier, W. M., Scheltens, P., Barkhof, F., Visser, M. C., Fazekas, F., Schmidt, R., O’Brien, J., Waldemar, G., Wallin, A., Chabriat, H., Pantoni, L., Inzitari, D., & Erkinjuntti, T. (2009). Longitudinal cognitive decline in subcortical ischemic vascular disease – the LADIS study. Cerebrovascular Diseases, 27, 384–391.

Kim, J. J., Schwartz, S., Wen, J., DeVirgilio, C., Lobue, A., Walot, I., Koopmann, M., Donayre, C., & White, R. A. (2015). Comparison of neurocognitive outcomes after carotid endarterectomy and carotid artery stenting. The American Surgeon, 81,1010-1014.

Koski, L. (2013). Validity and applications of the Montreal cognitive assessment for the assessment f vascular cognitive impairment. Cerebrovascular diseases,36, 6-18.

Kougias, P., Collins, R., Pastorek, N., Sharath, S., Barshes, N. R., McCulloch, K., Pisimisis, G., & Berger, D. H. (2015). Comparison of domain specific cognitive function after carotid endarterectomy and stenting. Journal of Vascular Surgery, 62(2), 355-61.

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general Internal Medicine, 16, 606-613.

Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatric annals, 32-39.

Mlekusch, W., Mlekusch, I., Minar, E., Haumer, M., Kopp, C. W., Ahmadi, R., Lehrner, J., & Schillinger, M. (2006). Is there improvement of “Vascular depression” after carotid artery stent placement. Radiology, 2, 508-514.

Nasreddine, Z. S. (2015, May). MoCa – Montreal Cognitive Assessment. Retrieved March 12, 2015, from www.mocatest.org.

Nasreddine, Z. S., Phillips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment. Journal of the American Geriatrics Society, 53(4), 695-699.

Popovic, I. M., Lovrencic-Huzjan, A., & Demarin, V. (2009). Assessment of subtle cognitive impairment in stroke-free patients with carotid disease. ActaClinicaCroatica, 48, 231–240.

Popovic, I. M., Lovrencic-Huzjan, A., Simundic, A. M., Popovic, A., Seric, V., & Demarin, V (2011). Cognitive performance in asymptomatic patients with advanced carotid disease. Cognitive and Behavioral Neurology, 24, 145–151.

Stek, M. L., Gussekloo, J., Beekman, A.T., van Tilburg, W., & Westendorp, R. G. (2004). Prevalence, correlates and recognition of depression in the oldest old: the Leiden 85-plus study. Journal of Affective Disorders, 78, 193–200.

Stewart, R. A., North, F. M., West, T. M., Sharples, K. L., Simes, R. J., Colquhoun, D. M., White, H. D., & Tonkin, A. M. (2003). Depression and cardiovascular morbidity and mortality: cause or consequence? European Heart Journal, 24, 2027-2037.

Vrublevska, J., Trapencieris, M., Snikere, S., Ivanovs, R., Berzina-Novikova, N., Zikusa, A., & Rancans, E. (2015). PHQ-9 validation in treatment seeking population in primary care setting in Latvia – the results of the pilot study of the National Research Project. European Neuropsychopharmacology, 25, S365.