The effect of white matter lesions on cognition after carotid revascularization

Aysun Altinbas*, Martine J. E. van Zandvoort, Esther van den Berg, Ale Algra, Gert Jan de Borst, Jeroen Hendrikse, Paul J. Nederkoorn, Leo H. Bonati, Martin M. Brown, L. Jaap Kappelle, H. Bart van der Worp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

11 Citations (Scopus)

Abstract

Background: Cerebral white matter lesions (WML) are associated with cognitive impairment, and carotid revascularization with cognitive worsening or improvement. We assessed the relation between WML severity and changes in cognition after carotid endarterectomy or stenting.

Methods: Patients with symptomatic carotid artery stenosis, enrolled in the International Carotid Stenting Study (ISRCTN25337470), underwent detailed neuropsychological examinations (NPEs) before and after 6 months. Cognitive results were standardized into z-scores, from which a sum score was calculated. The primary outcome was the mean difference (MD) in sum score between baseline and follow-up. Changes in sum score were related to WML severity with the 'age-related white matter changes' score, assessed on baseline MRI-FLAIR. Three groups were formed based on this score.

Results: Eighty-nine patients had both baseline MRI and NPE, of these 77 had a calculable cognitive difference score. The cognitive sum score at six months was worse than at baseline: MD, -0.21; 95% CI, -0.32 to -0.09. The change in sum score did not depend on WML load: MD for no-to-mild WMI, -0.15; 95% CI, -039 to 0.09, for moderate WML, -0.27; 95% CI, -0.48 to -0.06; and for severe WML, -021; 95% CI, -0.40 to -0.04. This did not change essentially after adjustment for baseline factors.

Conclusion: Cognitive functioning deteriorated after carotid revascularization, regardless of baseline WML burden. (C) 2013 Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)77-82
Number of pages6
JournalJournal of the Neurological Sciences
Volume334
Issue number1-2
DOIs
Publication statusPublished - 15 Nov 2013
Externally publishedYes

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