Changes in Cognition, Depression and Quality of Life after Carotid Stenosis Treatment.

BACKGROUND: Although several studies have evaluated the change of cognitive performance after severe carotid artery stenosis (CAS), the results still remain elusive. The objective of this study was to assess changes in cognitive function, depressive symptoms and health-related quality of life (HRQoL) after CAS revascularisation and best medical treatment (BMT).

METHODS: Study involved 213 patients with severe (≥70%) CAS who underwent assessment of cognitive function using Montreal Cognitive Assessment scale (MoCA), depressive symptoms - using Patient Health Questionnaire-9 (PHQ-9) and HRQoL - using Medical Outcome Survey Short Form version 2 (SF-36v2). The assessment was performed before carotid endarterectomy (CEA), n=159, percutaneous transluminal angioplasty (PTA), n=29 or BMT, n=25 and at 6 and 12 months follow-up periods.

RESULTS: Improvement on the total MoCA scores was observed after 6 and 12 months (p<0,001, Kendall's W=0,28) in the CEA group. In the PTA group - after 12 months (p=0,01, Kendall's W=0,261) whereas in the BMT group - no significant changes (p=0,295, Kendall's W=0,081). Reduction of depressive symptoms was not found in any of the study groups. Comparing mean SF-36v2 scores in the CAE group, there was no significant difference in any of 10 subscales. Likewise in the PTA group - no significant difference in 9 of 10 subscales (p=0,028, η2=0,343). Three subscales worsened in the BMT group during the 1 year follow-up period.

CONCLUSION: Patients with severe CAS who underwent revascularisation enhanced their cognitive performance without exerting significant change of depressive symptoms. Preoperative HRQoL may be maintained for at least one year in the CEA group.