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Kaszczewski P, Elwertowski M, Leszczyński J, Ostrowski T, Kaszczewska J, Stępkowski K, Maciąg R, Lamparski K, Gałązka Z. Impact of Internal Carotid Stenosis Treatment on Cerebral Blood Flow Volume: A Comparative Study between Preoperative and Postoperative Values. Med Sci Monit 2023; 29:e941958. [PMID: 38071424 PMCID: PMC10720253 DOI: 10.12659/msm.941958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Among patients with ICA stenosis, there are some cases with elevated, undisrupted, and diminished cerebral blood flow (CBF). The aim of this study was to assess the influence of ICA stenosis treatment on postoperative CBF changes in relation to preoperative CBF values. MATERIAL AND METHODS We qualified 58 patients ≥65 years old (28 males, 30 females, mean age 71.02±6.34 years) for surgical intervention due to symptomatic ≥70% ICA stenosis. In all patients, a flow volume in all extracranial arteries (internal carotid [ICA], external carotid [ECA], and vertebral arteries [VA]) was measured preoperatively and 2-3 days following the surgery. The CBF values were compared with the ones established for a healthy population of the same age. RESULTS Preoperatively, there were 3 subgroups of patients, comparing to healthy population: with elevated CBF - "significant compensation," with undisrupted CBF - "mild compensation," and with diminished CBF - "no compensation." Postoperatively, a significant CBF increase was observed in patients with preoperative "no" and "mild compensation" - 277.18±154.26 ml/min (P=0.0000001) and 221.56±98.8 ml/min (P=0.0000001). In a "significant compensation" group, there was no flow increase observed (CBF change of 2.57±58.5 ml/min, P=0.954) - a redistribution of flow was observed. CONCLUSIONS In patients with lower preoperative CBF values, surgical treatment caused a significant increase in global cerebral inflow, which was more prominent in patients with the lowest preoperative CBF. In patients with high preoperative CBF, surgical treatment resulted in a flow redistribution, but did not cause a CBF increase. Volumetric flow assessment in DUS can predict hemodynamic benefit from surgery in terms of CBF increase.
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Affiliation(s)
- Piotr Kaszczewski
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
| | - Michał Elwertowski
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
| | - Jerzy Leszczyński
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
| | - Tomasz Ostrowski
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
| | - Joanna Kaszczewska
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
| | - Kamil Stępkowski
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
| | - Rafał Maciąg
- II Division of Radiology, Medical University of Warsaw, Warsaw,
Poland
| | | | - Zbigniew Gałązka
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
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Chroboczek M, Kujach S, Łuszczyk M, Grzywacz T, Soya H, Laskowski R. Acute Normobaric Hypoxia Lowers Executive Functions among Young Men despite Increase of BDNF Concentration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10802. [PMID: 36078520 PMCID: PMC9518314 DOI: 10.3390/ijerph191710802] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Decreased SpO2 during hypoxia can cause cognitive function impairment, and the effects of acute hypoxia on high-order brain functions such as executive processing remain unclear. This study's goal was to examine the impact of an acute normobaric hypoxia breathing session on executive function and biological markers. METHODS Thirty-two healthy subjects participated in a blind study performing two sessions of single 30 min breathing bouts under two conditions (normoxia (NOR) and normobaric hypoxia (NH), FIO2 = 0.135). The Stroop test was applied to assess cognitive function. RESULTS No significant difference was observed in the Stroop interference in the "reading" part of the test in either condition; however, there was a significant increase in the "naming" part under NH conditions (p = 0.003), which corresponded to a significant decrease in SpO2 (p < 0.001). There was a significant increase (p < 0.013) in the brain-derived neurotrophic factor (BDNF) level after NH conditions compared to the baseline, which was not seen in NOR. In addition, a significant drop (p < 0.001) in cortisol levels in the NOR group and a slight elevation in the NH group was noticed. CONCLUSIONS According to these findings, acute hypoxia delayed cognitive processing for motor execution and reduced the neural activity in motor executive and inhibitory processing. We also noted that this negative effect was associated with decreased SpO2 irrespective of a rise in BDNF.
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Affiliation(s)
- Maciej Chroboczek
- Department of Physiology, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Sylwester Kujach
- Department of Physiology, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Marcin Łuszczyk
- Department of Physiology, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Tomasz Grzywacz
- Department of Sport, Institute of Physical Education, Kazimierz Wielki University, 85-064 Bydgoszcz, Poland
| | - Hideaki Soya
- Sports Neuroscience Division, Advanced Research Initiative for Human High Performance, Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba 305-8574, Japan
| | - Radosław Laskowski
- Department of Physiology, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
- Laboratory of Exercise Biochemistry and Neuroendocrinology, Department of Sports Neuroscience, Advanced Research Initiative for Human High Performance (ARIHHP), Faculty of Health and Sports Sciences, University of Tsukuba, Ibaraki 305-8577, Japan
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Relander K, Hietanen M, Rämö J, Vento A, Tikkala I, Roine RO, Lindsberg PJ, Soinne L. Differential Cognitive Functioning and Benefit From Surgery in Patients Undergoing Coronary Artery Bypass Grafting and Carotid Endarterectomy. Front Neurol 2022; 13:824486. [PMID: 35350398 PMCID: PMC8957972 DOI: 10.3389/fneur.2022.824486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Stenosing atherosclerosis in both coronary and carotid arteries can adversely affect cognition. Also their surgical treatments, coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA), are associated with cognitive changes, but the mechanisms of cognitive decline or improvement may not be the same. This study was designed to compare the cognitive profile and outcome in patients undergoing surgical treatment for coronary or carotid disease. Methods A total of 100 CABG patients and 44 CEA patients were recruited in two previously reported studies. They were subjected to a comprehensive neuropsychological examination prior to surgery and in the acute (3-8 days) and stable (3 months) phase after operation. A group of 17 matched healthy controls were assessed with similar intervals. We used linear mixed models to compare cognitive trajectories within six functional domains between the CABG, CEA and control groups. Postoperative cognitive dysfunction (POCD) and improvement (POCI) were determined with the reliable change index method in comparison with healthy controls. Results Before surgery, the CEA patients performed worse than CABG patients or healthy controls in the domains of executive functioning and processing speed. The CABG patients exhibited postoperative cognitive dysfunction more often than the CEA patients in most cognitive domains in the acute phase but had regained their performance in the stable phase. The CEA patients showed more marked postoperative improvement in executive functioning than the CABG group in the acute phase, but the difference did not reach significance in the stable phase. Conclusion Our findings suggest that anterior cerebral dysfunction in CEA patients impairs preoperative cognition more severely than global brain dysfunction in CABG patients. However, CEA may have more beneficial effects on cognition than CABG, specifically in executive functions mainly operated by the prefrontal lobes. In addition, the results underline that POCD is a heterogeneous condition and dependent on type of revascularization surgery.
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Affiliation(s)
- Kristiina Relander
- Division of Neuropsychology, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marja Hietanen
- Division of Neuropsychology, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juhani Rämö
- Division of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Antti Vento
- Division of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Irene Tikkala
- Division of Neuropsychology, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Risto O Roine
- University of Turku and Turku University Hospital, Turku, Finland
| | - Perttu J Lindsberg
- Department of Neurology, Neurocenter, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Lauri Soinne
- Department of Neurology, Neurocenter, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
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Effect of Acute Normobaric Hypoxia Exposure on Executive Functions among Young Physically Active Males. J Clin Med 2021; 10:jcm10081560. [PMID: 33917691 PMCID: PMC8068023 DOI: 10.3390/jcm10081560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background: On the one hand, hypoxic exposure may result in progressive brain metabolism disturbance, causing subsequent cognitive impairments. On the other hand, it might also enhance neurogenesis and brain vascularization as well as accelerate cerebral blood flow, leading to cognitive function improvement. The aim of this study was to investigate whether progressive stages of normobaric hypoxia (NH) (FIO2 = 13%, FIO2 = 12%, and FIO2 = 11%) differentially affect post-exposure cognitive performance. Methods: Fifteen physically active men (age = 23.1 ± 2.1) participated in the study. The Stroop test (ST) was applied to assess cognitive function. To generate NH conditions, a hypoxic normobaric air generator was used. Results: We observed an executive function impairment (“naming” interference p < 0.05) after NH exposure (FIO2 = 13%). After exposure at FIO2 = 12% and FIO2 = 11%, no changes were observed in the Stroop test. Also, changes in SpO2 during subsequent NH exposure were observed. Conclusions: The current investigation shows that executive functions deteriorate after acute NH exposure and this post-exposure deterioration is not proportional to the normobaric hypoxia stages among young physically active males.
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Comparison of Subjective and Objective Assessments on Improvement in Gait Function after Carotid Endarterectomy. SENSORS 2020; 20:s20226590. [PMID: 33218023 PMCID: PMC7698780 DOI: 10.3390/s20226590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022]
Abstract
The purpose of the present study was to determine whether objective gait test scores obtained using a tri-axial accelerometer can detect subjective improvement in gait as determined by the patient after carotid endarterectomy (CEA). Each patient undergoing CEA for ipsilateral internal carotid artery stenosis determined whether their gait was subjectively improved at six months after CEA when compared with preoperatively. Gait testing using a tri-axial accelerometer was also performed preoperatively and six months postoperatively. Twelve (15%) of 79 patients reported subjectively improved gait. Areas under the receiver operating characteristic curve for differences between pre- and postoperative test values in stride time, cadence, and ground floor reaction for detecting subjectively improved gait were 0.995 (95% confidence interval (CI), 0.945-1.000), 0.958 (95%CI, 0.887-0.990), and 0.851 (95%CI, 0.753-0.921), respectively. Cut-off points for value differences in detecting subjectively improved gait were identical to mean -1.7 standard deviation (SD) for stride time, mean +1.6 SD for cadence, and mean +0.4 SD for ground floor reaction of control values from normal subjects. Objective gait test scores obtained using the tri-axial accelerometer can detect subjective gait improvements after CEA. When determining significant postoperative improvements in gait using a tri-axial accelerometer, optimal cut-off points for each test value can be defined.
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Ando T, Shimada Y, Fujiwara S, Yoshida K, Kobayashi M, Kubo Y, Terasaki K, Ando S, Ogasawara K. Revascularisation surgery improves cognition in adult patients with moyamoya disease. J Neurol Neurosurg Psychiatry 2020; 91:332-334. [PMID: 31836638 DOI: 10.1136/jnnp-2019-321069] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/30/2019] [Accepted: 12/04/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Toshihiko Ando
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan.,Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Yasuyoshi Shimada
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan.,Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Masakazu Kobayashi
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan.,Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | | | - Satoshi Ando
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan .,Cyclotron Research Center, Iwate Medical University, Morioka, Japan
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Hara S, Seida M, Kumagai K, Yamamoto T. Beneficial Effect of Carotid Artery Stenting on Cerebral Hemodynamic Impairment and Cognitive Function. Neurol Med Chir (Tokyo) 2019; 60:66-74. [PMID: 31748442 PMCID: PMC7040432 DOI: 10.2176/nmc.oa.2019-0147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to evaluate the effects of the carotid artery stenting (CAS) procedure on cerebral hemodynamics and cognitive performance in patients with internal carotid artery stenosis. In this prospective observational study, 16 consecutive patients in a single institute were treated with CAS from 2010 to 2011 (71.7 ± 7.3 years old, 12 males, and six left-sided procedures). Before and after the CAS procedure, all patients were evaluated with single photon emission computed tomography using 123
I-iodoamphetamine and acetazolamide as well as the Weschler Adult Intelligent Scale (WAIS) to assess three intelligent quotients and four indexes. Patients with decreased preprocedural cerebral blood flow (CBF) and cerebrovascular reserve (CVR) experienced significant increases in CBF and CVR (P = 0.01 and 0.03). Twelve (75%) patients experienced a significant increase in one or more WAIS scores, while two (13%) showed a significant decrease. The most frequently improved scores were the Working Memory Index and Processing Speed Index (seven patients/44%). Preprocedural CBF was significantly correlated with the Full-scale and Performance Intelligent Quotients (r = 0.51–0.56, P = 0.02–0.04), and patients who experienced a significant increase in these scores had larger increases in CVR than patients with unchanged scores (P = 0.0097–0.019). These results indicate that the CAS procedure improved impaired cerebral hemodynamics and might benefit the cognitive function of patients with internal carotid artery stenosis related to impaired cerebral hemodynamics.
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Affiliation(s)
- Shoko Hara
- Department of Neurosurgery, Toshima Hospital, Tokyo Metropolitan Health and Hospitals Corporation
| | - Mitsuru Seida
- Department of Neurosurgery, Toshima Hospital, Tokyo Metropolitan Health and Hospitals Corporation
| | - Kotaro Kumagai
- Department of Neurosurgery, Toshima Hospital, Tokyo Metropolitan Health and Hospitals Corporation
| | - Takahiro Yamamoto
- Department of Neurosurgery, Toshima Hospital, Tokyo Metropolitan Health and Hospitals Corporation
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