Cognitive performance in elderly patients undergoing carotid endarterectomy or carotid artery stenting: A twelve-month follow-up study

Background: It is still a matter of debate if and to what extent carotid endarterectomy (CEA) and carotid artery stenting (CAS) impair cognitive functioning in the elderly. Methods: We conducted a nonrandomized clinical trial on subjects with asymptomatic carotid artery stenosis comparing CEA (n = 28; 24 males and 4 females; 72.6 ± 5.8 years old) with CAS (n = 29; 17 males and 12 females; 75.1 ± 5.7 years old). Cognition, mood and functional status were evaluated by a broad spectrum of tests performed on the day prior to carotid reopening as well as 3 and 12 months after. Results: No significant differences in scores on cognitive tests including the Babcock story recall test and Rey's auditory verbal learning test (memory), category naming test (verbal fluency), trail-making test parts A and B (attention and executive function) and controlled oral word association test (executive functioning) were observed 3 and 12 months after carotid reopening independent of the technique used. Only scores on the copy drawing test (visuospatial and constructional abilities) slightly but significantly (p < 0.05) worsened in the CAS group 12 months after the intervention. No significant differences between the CEA and CAS groups were detected regarding mood and functional status after 3 and 12 months. Conclusions: CEA and CAS seem to be safe procedures in elderly patients in terms of cognitive, mood and functional status in the short and long term. CAS might be preferred for the shorter hospital stay, but further studies with a larger number of old and oldest old subjects with a longer follow-up are needed to better understand the cost-effectiveness of both treatments

Fetal variant of circle of the Willis and bilateral symmetrical parietal stroke

We described a rare case in which a congenital abnormal vascular structure associated with mild hyperhomocysteinemia could have caused an ischemic stroke, with an unusual localization in the border-zone of MCA and PCA. We think that the lack of compensatory flow distribution from the right vertebral artery and the right posterior communicating artery probably determined the bilateral ischemic lesions in a patient, who possibly had hypotensive crisis.3 page(s

Performance cognitive in pazienti anziani sottoposti a endoarterectomia o a stenting carotideo: Studio di follow up a 12 mesi

Introduction. In this study we investigated short and long-term impact of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in cognitively healthy elderly subjects with severe carotid stenosis on several cognitive functions by neuropsychological evaluation before surgery and after three and twelve months. Methods. Cognition, mood and functional status were evaluated in 28 patients undergoing CEA (24 M, 4 F, 72.6 ± 5.8 years old) and in 29 patients undergoing CAS (17 M, 12 F, 75.1 ± 5.7 years old) by a broad spectrum of tests assessing mood, functional status, memory, attention, verbal fluency, visuospatial and constructional abilities. Results. No significant differences in scores at cognitive tests were observed three and twelve months after carotid reopening independently of the technique used. Only scores at Copy Drawing test (visuospatial and constructional abilities) slightly but significantly (p<0.05) worsened in the CAS group twelve months after intervention. No significant differences between CEA and CAS groups were detected regarding mood and functional status after 3 and 12 months. Discussion. Neither CEA nor CAS significantly affected cognitive, mood and functional status at short as well as at long-term. The choice of CAS, with a shorter hospital stay, might be indicated in elderly patients with severe carotid stenosis

How legislation on decisional capacity can negatively affect the feasibility of clinical trials in patients with dementia

Antipsychotic drugs are widely used to treat behavioural and psychological disturbances associated with Alzheimer's disease (AD), although only modest evidence from randomized controlled trials supports their efficacy, and increasing evidence from post-marketing surveillance shows serious adverse events associated with their use, including increased mortality. The AdCare study, a non-profit, randomized, placebo-controlled, double-blind, multicentre, pragmatic trial coordinated by the Italian National Institute of Health, aimed to evaluate the long-term safety and efficacy profiles of three atypical antipsychotic drugs (risperidone, olanzapine and quetiapine) and one conventional antipsychotic drug (haloperidol) in treating psychosis, aggression and agitation in outpatients with AD. The study was planned to be carried out in 19 clinical centres and to enrol 1000 outpatients. According to Italian law, in the case where a patient is considered unable to give informed consent, a legal representative designated by the court has to provide it. Because of difficulties in the informed consent procedure, the study had to be prematurely interrupted. From February 2009 to April 2010, 83 patients gave informed consent to participate in the trial. Fifty-six patients (68%) were included with consent given by a legal representative, while 27 patients (32%) were considered to provide personal informed consent on the basis of the results from a specifically built procedure. Patients and caregivers were offered the opportunity to participate in the trial before the occurrence of behavioural disturbances, in order to provide them with enough time to consider their participation in the study. Twenty-three patients experienced behavioural, clinically relevant symptoms and were randomized to the study drug; all randomized patients except one had consent for inclusion in the study given by legal representatives. After trial interruption, all patients taking an active drug continued treatment with the same molecule in clinical practice. Randomized controlled trials are acknowledged as the gold standard source of evidence on drug safety and efficacy. The AdCare study showed that an excessively rigid regulation can become a major obstacle while carrying out therapeutic research with incapacitated persons