Cognitive And Balance Improvement After Carotid Endarterectomy In Asymptomatic Patients: A Prospective Study.

INTRODUCTION

Recent studies proved impaired cognition, mobility and balance in patients with significant asymptomatic carotid stenosis (ACAS) in comparison to general adult population. In our study, we tested the hypothesis that patients with severe ACAS ( ≥70%≥70% diameter- reducing stenosis) would have long- term cognitive, mobility and balance improvement after carotid revascularization.

METHODS

All asymptomatic patients who underwent carotid endarterectomy from a 20- month period in our institution were prospectively enrolled. Cognitive, mobility and balance tests were performed the week before surgery and had postoperative re- evaluation at 6- 8 months. Executed tests were Mini- Mental State Exam (MMSE), Timed Up and Go test (TUG), 2 Minute Walk Test (2MWT), Berg Balance Scale (BBS) and Activities- specific Balance Confidence (ABC) Scale.

RESULTS

18 patients were recruited. The mean age was 70.11±7.2970.11±7.29 years, 72.22%72.22% were man, 44.44%44.44% had severe unilateral stenosis and the remaining bilateral stenosis. Patients had impaired scores at baseline, ranging from 11.11%11.11%to 44.44%44.44% . Post- operative upgrading in absolute score was noted in all tests (p<.021)(p<.021) except TUG, and greatest improvement in the percentage of compromised scores was noted in BBS (relative risk 6.6, p=.025p=.025 ). A strong negative correlation was verified between several baseline absolute scores and the level of postoperative variation (r=-0.87(r=-0.87 for MMSE, r=0.80r=0.80 for TUG and r=0.82r=0.82 for BBS with p<.001p<.001 , and r=0.52r=0.52 for ABC with p=.032p=.032 .

CONCLUSION

Carotid endarterectomy improved balance and cognition in a group of asymptomatic patients with severe carotid stenosis. Greatest improvements were noted in dynamic movement tests with most reduced scores at baseline.