Changes in Cognitive Function After Carotid Endarterectomy in Older Patients: Comparison With Younger Patients

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概要

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• Objective and subjective assessments of changes in cognition after carotid endarterectomy (CEA) were compared between older patients (≥76 years old) and younger patients (<76 years old). Patients underwent subjective cognitive assessment by a neurosurgeon and the patient's next of kin, and neuropsychological testing (five parameters) before and after surgery. Of 37 older patients studied, 4 (11%), 28 (75%), and 5 (14%) patients were defined as having subjectively improved, unchanged, and impaired cognition, respectively, following surgery. Differences in test scores (postoperative test score − preoperative test score: Δ score) in all neuropsychological tests were significantly lower in the older patients than in the 213 younger patients. The Δ score was able to statistically differentiate older patients with subjectively improved, unchanged, and impaired cognition after surgery. Receiver operating characteristic analysis showed that the Δ score cut-off point for detecting subjective improvement (upper cut-off point) and impairment (lower cut-off point) in cognition after surgery in older patients was identical to the mean or the mean +0.5 standard deviation (SD) and the mean −1.5 SD or the mean −1 SD, respectively, of the control value obtained from normal subjects. The upper and lower cut-off points were lower and higher, respectively, than those in younger patients. In conclusion, although neuropsychological test scores reflect the subjective assessment of postoperative change in cognition in older patients, the optimal cut-off points for the test scores to detect subjective improvement and impairment in cognition after CEA are different in older patients compared with younger patients.

著者

• Ogasawara Kuniaki

  Department Of Neurosurgery Iwate Medical University

• Kobayashi Masakazu

  Departmdepartment Of Cardiology Nagoya University Graduate School Of Medicine

• Beppu Takaaki

  Department Of Neurosurgery Iwate Medical University School Of Medicine

• Kubo Yoshitaka

  Department Of Neurosurgery Iwate Medical University

• Ogawa Akira

  Department Of Applied Chemistry Graduate School Of Engineering The University Of Tokyo

• Matsumoto Yuuki

  Department Of Mechano-micro Engneering Interdisciplinary Graduate School Of Science And Engineering

• Takahashi Yoshihiro

  Department Of Applied Physics Osaka City University

• Yoshida Kenji

  Department of Biochemistry, Kinki University School of Medicine

• MURAKAMI Toshiyuki

  Department of Neurosurgery, Iwate Medical University

• NANBA Takamasa

  Department of Neurosurgery, Iwate Medical University

• MATSUMOTO Yuuki

  Department of Neurosurgery, Iwate Medical University

• BEPPU Takaaki

  Department of Neurosurgery, Iwate Medical University

• TAKAHASHI Yoshihiro

  Department of Neurosurgery, Iwate Medical University

• YOSHIDA Kenji

  Department of Neurosurgery, Iwate Medical University

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