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

Association of increased carotid intima-media thickness and lower plasma levels of vitamin C and vitamin E in old age subjects: implications for Alzheimer's disease

In light of the recent advances regarding the role of vascularity in Alzheimer's disease (AD) pathophysiology, the relationship between plasma levels and activities of the major antioxidant molecules and the carotid intima-media thickness (C-IMT) of older persons with no or very mild cognitive impairment was evaluated. The underlying hypothesis is that the IMT may be an indirect index of vascular damage in persons with low levels of plasma antioxidants. Plasma levels of vitamins A, C, E, of uric acid as well as activities of the plasma antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx) were measured. Plasma levels of vitamins C and E significantly decreased among participants from the first to the fourth IMT quartile, with a linear slope only for vitamin C. Compared to participants in the lowest vitamin C quartile, the probability to have IMT > 1.2 mm significantly decreased among persons from the second to the fourth quartile independent of confounders. In conclusion, only vitamin C plasma levels appear to be selectively associated with the risk of increasing C-IMT. An adequate vitamin C status might be particularly important for protection against AD and other clinical manifestations of vascular and cognitive ageing

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