Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Relander, Kristiina; Hietanen, Marja; Nuotio, Krista; Ijäs, Petra; Tikkala, Irene; Saimanen, Eija; Lindsberg, Perttu J.; Soinne, Lauri

doi:10.3389/fneur.2020.593719

Cited by 19 publications

(22 citation statements)

References 30 publications

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“…This study was performed in the Helsinki University Hospital, Finland. The data comprised of patient groups from two studies described earlier: the CEA group ( 13 , 38 ) and the CABG group ( 10 ). Both studies were approved by the ethical committee of the Helsinki University Hospital and performed according to the ethical standards of the Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

“…Postoperative cognitive impairment after CEA or CABG has been associated with lower quality of life (34), adverse long-term cognition (10,(35)(36)(37) and higher mortality (35,38,39). However, differences in postoperative cognitive outcome between CABG and CEA are yet to be investigated.…”

Section: Introductionmentioning

confidence: 99%

“…The aim of this study was to compare the cognitive profile and outcome in patients undergoing surgical treatment for carotid or coronary disease in two cohorts from previously reported studies. Based on our previous findings ( 10 , 38 ) we hypothesized that carotid disease causing territorial cerebral hypoperfusion would be associated with a deeper and more localized cognitive preoperative deficit in CEA patients and correspondingly a more pronounced postoperative improvement, whereas CABG would be associated with a more general short-term postoperative decline.…”

Section: Introductionmentioning

confidence: 99%

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Differential Cognitive Functioning and Benefit From Surgery in Patients Undergoing Coronary Artery Bypass Grafting and Carotid Endarterectomy

et al. 2022

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BackgroundStenosing atherosclerosis in both coronary and carotid arteries can adversely affect cognition. Also their surgical treatments, coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA), are associated with cognitive changes, but the mechanisms of cognitive decline or improvement may not be the same. This study was designed to compare the cognitive profile and outcome in patients undergoing surgical treatment for coronary or carotid disease.MethodsA total of 100 CABG patients and 44 CEA patients were recruited in two previously reported studies. They were subjected to a comprehensive neuropsychological examination prior to surgery and in the acute (3–8 days) and stable (3 months) phase after operation. A group of 17 matched healthy controls were assessed with similar intervals. We used linear mixed models to compare cognitive trajectories within six functional domains between the CABG, CEA and control groups. Postoperative cognitive dysfunction (POCD) and improvement (POCI) were determined with the reliable change index method in comparison with healthy controls.ResultsBefore surgery, the CEA patients performed worse than CABG patients or healthy controls in the domains of executive functioning and processing speed. The CABG patients exhibited postoperative cognitive dysfunction more often than the CEA patients in most cognitive domains in the acute phase but had regained their performance in the stable phase. The CEA patients showed more marked postoperative improvement in executive functioning than the CABG group in the acute phase, but the difference did not reach significance in the stable phase.ConclusionOur findings suggest that anterior cerebral dysfunction in CEA patients impairs preoperative cognition more severely than global brain dysfunction in CABG patients. However, CEA may have more beneficial effects on cognition than CABG, specifically in executive functions mainly operated by the prefrontal lobes. In addition, the results underline that POCD is a heterogeneous condition and dependent on type of revascularization surgery.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Differential Cognitive Functioning and Benefit From Surgery in Patients Undergoing Coronary Artery Bypass Grafting and Carotid Endarterectomy

et al. 2022

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“…It is important to note that PND is not a harmless disease. Not only does it lead to longer hospital length of stay, higher costs, and increased readmission rates, but it may also increase 5-year mortality after surgery [ 6 , 7 ]. In addition, postoperative delirium may accelerate the deterioration of cognitive function in elderly patients and is associated with a decline in neurocognitive function in the distant postoperative period [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Ferroptosis is involved in regulating perioperative neurocognitive disorders: emerging perspectives

Song

Xue

et al. 2022

J Neuroinflammation

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Since the twenty-first century, the development of technological advances in anesthesia and surgery has brought benefits to human health. However, the adverse neurological effects of perioperative-related factors (e.g., surgical trauma, anesthesia, etc.) as stressors cannot be ignored as well. The nervous system appears to be more “fragile” and vulnerable to damage in developing and aging individuals. Ferroptosis is a novel form of programmed cell death proposed in 2012. In recent years, the regulation of ferroptosis to treat cancer, immune system disorders, and neurodegenerative diseases have seen an unprecedented surge of interest. The association of ferroptosis with perioperative neurocognitive disorders has also received much attention. Cognitive impairment can not only affect the individual’s quality of life, but also impose a burden on the family and society. Therefore, the search for effective preventive and therapeutic methods to alleviate cognitive impairment caused by perioperative-related factors is a challenge that needs to be urgently addressed. In our review, we first briefly describe the connection between iron accumulation in neurons and impairment of brain function during development and aging. It is followed by a review of the pathways of ferroptosis, mainly including iron metabolism, amino acid metabolism, and lipid metabolism pathway. Furthermore, we analyze the connection between ferroptosis and perioperative-related factors. The surgery itself, general anesthetic drugs, and many other relevant factors in the perioperative period may affect neuronal iron homeostasis. Finally, we summarize the experimental evidence for ameliorating developmental and degenerative neurotoxicity by modulating ferroptosis. The suppression of ferroptosis seems to provide the possibility to prevent and improve perioperative neurocognitive impairment.

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“…Perioperative neurocognitive disorders (PND) are a group of disorders manifest in relation to surgery and anesthesia ( Evered et al, 2018a ) and encompass former classifications of perioperative cognitive derangements, such as postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). PND are common following anesthesia and surgery, affecting up to 65% of adults over age 65 years ( Rudolph and Marcantonio, 2011 ), and conferring significant morbidity ( Suraarunsumrit et al, 2022 ) and mortality ( Roach et al, 1996 ; Evered et al, 2016 ; Kok et al, 2017 ; Relander et al, 2020 ). Despite the high estimated incidence of PND in older adults, the true incidence is likely higher as most patients do not receive baseline or follow-up neurocognitive testing in the perioperative period and beyond, limiting identification and early intervention.…”

Section: Introductionmentioning

confidence: 99%

Mitigation of perioperative neurocognitive disorders: A holistic approach

Safavynia

Goldstein

Evered

2022

Front. Aging Neurosci.

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William Morton introduced the world to ether anesthesia for use during surgery in the Bullfinch Building of the Massachusetts General Hospital on October 16, 1846. For nearly two centuries, the prevailing wisdom had been that the effects of general anesthetics were rapidly and fully reversible, with no apparent long-term adverse sequelae. Despite occasional concerns of a possible association between surgery and anesthesia with dementia since 1887 (Savage, 1887), our initial belief was robustly punctured following the publication in 1998 of the International Study of Post-Operative Cognitive Dysfunction [ISPOCD 1] study by Moller et al. (1998) in The Lancet, in which they demonstrated in a prospective fashion that there were in fact persistent adverse effects on neurocognitive function up to 3 months following surgery and that these effects were common. Since the publication of that landmark study, significant strides have been made in redefining the terminology describing cognitive dysfunction, identifying those patients most at risk, and establishing the underlying etiology of the condition, particularly with respect to the relative contributions of anesthesia and surgery. In 2018, the International Nomenclature Consensus Working Group proposed new nomenclature to standardize identification of and classify perioperative cognitive changes under the umbrella of perioperative neurocognitive disorders (PND) (Evered et al., 2018a). Since then, the new nomenclature has tried to describe post-surgical cognitive derangements within a unifying framework and has brought to light the need to standardize methodology in clinical studies and motivate such studies with hypotheses of PND pathogenesis. In this narrative review, we highlight the relevant literature regarding recent key developments in PND identification and management throughout the perioperative period. We provide an overview of the new nomenclature and its implications for interpreting risk factors identified by clinical association studies. We then describe current hypotheses for PND development, using data from clinical association studies and neurophysiologic data where appropriate. Finally, we offer broad clinical guidelines for mitigating PND in the perioperative period, highlighting the role of Brain Enhanced Recovery After Surgery (Brain-ERAS) protocols.

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Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Cited by 19 publications

References 30 publications

Differential Cognitive Functioning and Benefit From Surgery in Patients Undergoing Coronary Artery Bypass Grafting and Carotid Endarterectomy

Differential Cognitive Functioning and Benefit From Surgery in Patients Undergoing Coronary Artery Bypass Grafting and Carotid Endarterectomy

Ferroptosis is involved in regulating perioperative neurocognitive disorders: emerging perspectives

Mitigation of perioperative neurocognitive disorders: A holistic approach

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