Impact of Coronary Artery Disease on Long-Term Cognitive Outcome after Ca- rotid Endarterectomy

Abstract

Objective: Carotid stenosis and coronary artery disease (CAD) are associated with cognitive decline, but little is known about the impact of CAD on cognitive outcome after carotid endarterectomy (CEA). The aim of this study was to assess the long-term cognitive outcomes after CEA in patients with CAD and to identify causative risk factors for cognitive decline.Methods: Among 36 consecutive patients with CAD who had undergone CEA between February 2016 and June 2018, and 45 patients without CAD who had undergone CEA during the same period, cognitive functions were studied using the Neurobehavioral Cognitive Status Examination (Cognistat) and the Frontal Assessment Battery (FAB). Cognitive decline was defined as both FAB total score below the cutoff value and severe impairment in at least one domain on Cognistat.Results: Cognitive decline was evident in 27.8% of patients with CAD at a mean of 7.2 years after CEA, and in 8.9% of patients without CAD. Comprehension, memory, and conceptualization were significantly impaired in patients with CAD compared to patients without CAD (p=0.0274, 0.0392, and 0.0113, respectively).In patients with CAD, univariate analysis revealed that deep white matter hyperintensity (DWMH) and chronic kidney disease associated with cognitive decline (odds ratio (OR) 32.2, 95% confidence interval (CI) 3. p=0.0032; OR 6.11, p=0.0360, respectively).Conclusions: This result may be useful to better identify individuals at high risk of cognitive decline long after CEA.