[Validity of test scales for neurocognitive and psychoemotional testing in patients with surgical pathology of precerebral arteries]

POSTOPERATIVE COGNITIVE DISORDERS IN PATIENTS UNDER CAROTID ENDARTERECTOMY

Evaluation of the impact of carotid endarterectomy on the cognitive status of patients remains debatable, since patients with atherosclerotic lesions of the carotid arteries suffer from chronic cerebrovascular insufficiency, and changes in the cognitive status of patients after carotid endarterectomy may be due to factors such as increased blood supply to the brain, microembolism after the start of blood flow, and cerebral ischemia during cross-clamping and also the effect of various anesthesia drugs on the cognitive status in these patients is ambiguous.Purpose. To assess age-related changes in cognitive status in patients with atherosclerotic lesions of the carotid arteries in the postoperative periodMaterial and methods. Neuropsychological testing was performed in 128 patients after eversion carotid endarterectomy, divided into age groups and depending on the methods of anesthesia: Propofol group and Sevoflurane group.Results. In patients under the age of 60 years, there is an improvement in cognitive status in the early and late postoperative period, while in patients of the older age group, there is a slowdown in the progression of cognitive dysfunction in both groups of anesthesia.Conclusion. An important criterion for evaluating the surgical prevention of cerebrovascular accidents is clinical effectiveness, in particular, the impact of operations and anesthesia methods on the cognitive sphere of patients of different ages with pathology of the main arteries of the head, which determines the quality of life not only for patients, but also for relatives.

[Surgical prevention of progressive cerebral ischemia after ischemic stroke]

OBJECTIVE

To evaluate the effectiveness of carotid endarterectomy after ischemic stroke and to analyze postoperative neurological status.

MATERIAL AND METHODS

There were 120 patients with carotid artery stenosis complicated by chronic cerebrovascular insufficiency (CVI). Patients with CVI grade I-III were included in the first group (n=70), 50 patients had previous ischemic stroke (the second group). Age of patients was 61-89 years. All patients underwent unilateral carotid endarterectomy.

RESULTS

Over 36-month follow-up period, postoperative stroke occurred in 5 (7.2%) and 9 (18.3%) patients in both groups, respectively. The combined end-point (stroke + mortality) was significantly less common in group I compared to group II (10 (14.5%) and 15 (30%) cases, p>0.05). Positive changes in neurological status were found in the 2^nd group (relief of focal neurological deficit, symptoms of cerebrovascular insufficiency, no progression of vascular dementia). Barthel score increased from 74.3 to 92.8 after carotid endarterectomy in the 2^nd group. Baseline FAB score <11 was observed in 9% of patients in the 1^st group and 22% in the 2^nd group. No progression of dementia was observed in long-term period.

CONCLUSION

Carotid endarterectomy is effective in prevention of primary and recurrent stroke. Moreover, this procedure slows down progression of chronic cerebral ischemia and cognitive impairment.

[Early and long-term cognitive disorders after carotid endarterectomy]

AIM

To identify correlation of carotid endarterectomy with neurocognitive function and psycho-emotional state changes.

MATERIAL AND METHODS

There were 120 patients with internal carotid arteries (ICA) stenoses for the period from September 2013 to December 2016. The main group consisted of 100 patients undergoing carotid endarterectomy for internal carotid artery stenosis, control group - 20 patients who refused surgery in 2014-2016. Cognitive function and psycho-emotional state were assessed preoperatively, after 24 hours, 7 days and 3, 6 months postoperatively using the Mini Mental State Examination (MMSE), Frontal assessment battery (FAB), Information-Memory-Concentration Test, Clock Drawing Test and Schulte`s test, Luria Memory Words Test, Hospital Anxiety and Depression Scale (HADS) and Covi Anxiety Scale.

RESULTS

Moderate preoperative cognitive impairment was observed in 39 (39%) patients of the main group. De novo postoperative cognitive dysfunction occurred in 65 patients on the 1^st day after surgery (65%). Disturbances were noted after 1 week in 26%, after 3 months - in 15%, after 6 months - in 10% of patients. Improved status was noted in 31 (31%) patients of the main group within 1 day after surgery. Improved results were observed after 7 days in 52 (52%) patients, after 3 months - in 67 (67%), after 6 months - in 78 (78%) patients. Mean values of psycho-emotional testing in the main group were high before surgery and significantly decreased on the 1^st day after operation. However, advanced anxiety and aggravation of depression occurred in 14% of patients (n=14) that affected cognitive sphere (p<0.01). Progressive cognitive impairment was noted in the control group.

CONCLUSION

Carotid endarterectomy has a positive long-term effect on initially impaired neurocognitive functions (3 and 6 months) (p<0.05). There were no significant differences in cognitive testing data in subgroups of eversion and classical procedures (p>0.05). Early postoperative depressive disorders significantly increase the risk of postoperative cognitive dysfunction.