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A Controlled Prospective Study of Neuropsychological Dysfunction Following Carotid Endarterectomy
Eric J. Heyer, MD, PhD;
Ruchey Sharma, BA;
Anita Rampersad, BA;
Christopher J. Winfree, MD;
William J. Mack, BA;
Robert A. Solomon, MD;
George J. Todd, MD;
Paul C. McCormick, MD;
James G. McMurtry, MD;
Donald O. Quest, MD;
Yaakov Stern, PhD;
Ronald M. Lazar, PhD;
E. Sander Connolly, MD
Arch Neurol. 2002;59:217-222.
Background Although subtle cognitive injury as revealed by neuropsychological testing
occurs in a substantial number of patients following carotid endarterectomy
(CEA), there is controversy about whether this finding is a result of the
surgery or the anesthesia.
Objectives To examine the changes in neuropsychological test performance in patients
following CEA vs a control group of patients older than 60 years following
spine surgery, so as to determine whether neuropsychological dysfunction after
CEA is a result of surgery or anesthesia.
Methods Patients undergoing CEA (n = 80) and lumbar spine surgery (n = 25) were
assessed with a battery of neuropsychological tests preoperatively and on
postoperative days 1 and 30. The neuropsychological performance of patients
in the control group was used to normalize performance for patients in the
CEA group, by calculating z scores using the mean
and SD of the change scores in the control group. Significant cognitive dysfunction
was defined as performance that exceeded 2 SDs above the mean performance
of patients in the control group.
Results Postoperative days 1 and 30 total deficit scores were significantly
worse in the CEA group compared with the controls. When individual test results
were examined, the CEA group performed significantly worse than the controls
on the Rey Complex Figure test and Halstead-Reitan Trails B on day 1, and
on the Rey Complex Figure on day 30. Overall, cognitive dysfunction was seen
in 22 patients (28%) in the CEA group on day 1 and in 11 (23%) of 48 patients
on day 30.
Conclusions Subtle cognitive decline following CEA occurs and persists for at least
several weeks after surgery. This decline was absent in a control group.
From the Departments of Anesthesiology (Dr Heyer and Ms Rampersad),
Neurological Surgery (Ms Sharma and Drs Winfree, Solomon, McCormick, McMurtry,
Quest, Lazar, and Connolly, and Mr Mack), Neurology (Drs Heyer, Stern, and
Lazar), the Gertrude H. Sergievsky Center (Dr Stern), Department of Surgery,
St Luke's-Roosevelt Hospital Center (Dr Todd), and the Herbert and Florence
Irving Center for Clinical Research (Dr Connolly), Columbia University, New
York, NY.
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