Cognitive functioning and quality of life of atherosclerotic patients following carotid endarterectomy.

Abstract

Background: Carotid endarterectomy (CEA) is a surgical procedure to remove atherosclerotic plaque from one of the carotid arteries in patients with severe stenosis. The purpose is to prevent future cerebral ischemic attacks. Whether patients, in addition, improve in cognitive functions and quality of life (QoL) was investigated in this study. Methods: Patients with severe carotid stenosis were assessed on cognitive functions one day before and three months after CEA. The test battery included tests of memory, attention, psychomotor function, and laterality. Besides, the Cognitive Failures Questionnaire, the RAND 36-item Health Survey, and a mood questionnaire were administered. A comparison group was composed of patients undergoing peripheral vascular surgery of comparable duration and anesthesia. Results: So far, CEA patients showed significant postoperative cognitive improvement on a few tests, namely of short-term memory (Digit span forward), verbal laterality (Dichotic listening), attentional switching (Visual elevator), motor function (Finger tapping, Motor planning), and a trend for delayed verbal recall (15 Words). Peripheral vascular patients showed slight improvements on tasks of visual memory (Doors B), attention (Trailmaking B, Dichotic listening), and motor function (Motor planning). Concerning QoL, CEA patients showed postoperative improvements in physical functioning, mental health, and health perception, while peripheral vascular patients reported positive changes for physically related scales only. Furthermore, CEA patients noticed less fatigue, anger and tension, but these changes already existed on the day before surgery. Peripheral patients only reported less fatigue. Conclusions: This study suggests that, in addition to its medical aim, CEA improves subjective physical and mental QoL and negative mood states in severe atherosclerotic patients. In addition, some indications were found for improved cognitive functioning.