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

Abstract

Background: Although several studies have evaluated the change of cognitive performance after severe carotid artery stenosis, 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 carotid stenosis revascularisation and Best Medical Treatment (BMT).

Methods: Study involved 213 patients with ≥70% carotid stenosis 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 and at 6 and 12 months followup periods in patients who had Carotid Endarterectomy (CEA), Carotid Artery Stenting (CAS) or received BMT only.

Results: Improvement in 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 CAS 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) were observed. Reduction of depressive symptoms was not found in any of the study groups. Comparing mean SF-36v2 scores in the CEA group, there was no significant difference in any of 10 subscales. Likewise in the CAS group - no significant difference in 9 of 10 subscales (p=0.028, η2=0.343) was observed. Three subscales worsened in the BMT group during the 1-year follow-up period.

Conclusion: Patients with severe carotid stenosis 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.

Keywords: Cognition; carotid stenosis; depression; endarterectomy; medical treatment; quality of life; stenting..

Fig. (1)

Age differences in the carotid endarterectomy, carotid stenting and best medical treatment groups at baseline. Comparison of median age in males and females at baseline. Significant differences between male and female median age were in the CEA group where females were older than males. No significant age differences were observed in the CAS and BMT groups at baseline. Bar display median, boxes represent IQR, and whiskers display total range.

Fig. (2)

Median total MoCA scores at baseline, 6 and 12 months in carotid endarterectomy group. Significant increase of median total MoCA score as a measure of cognitive function at 6 and 12 months after successful CEA in patients with severe carotid stenosis. The difference of median MoCA scores between V2 and V3 is statistically significant, but the statistical effect size is small (r=0.2).

Fig. (3)

Median total MoCA scores at baseline, 6 and 12 months in carotid artery stenting group. Significant increase of median total MoCA score as a measure of cognitive function at 12 months after successful CAS in patients with severe carotid stenosis. No significant change of median MoCA score was observed between baseline and 6 months and between 6 and 12 months. Bar display median, boxes represent IQR, and whiskers display total range.

Fig. (4)

Changes in the frequency of depressive symptoms after 6 and 12 months in the carotid endarterectomy group. (A) Graph of percentage and number of patients with and without depressive symptoms at baseline and 6 months after CEA. The graph depicts number of patients who did not have depressive symptoms at baseline but felt depressed after 6 months. Likewise, number of patients who had depressive symptoms at baseline but did get better or remained depressed after 6 months. (B) Graph of percentage and number of patients with and without depressive symptoms at baseline and 12 months after CEA. The graph depicts number of patients who did not have depressive symptoms at baseline but felt depressed after 12 months. Likewise, number of patients who had depressive symptoms at baseline but did get better or remained depressed after 12 months.

Fig. (5)

Changes in the frequency of depressive symptoms after 6 and 12 months in the carotid artery stenting group. (A) Graph of percentage and number of patients with and without depressive symptoms at baseline and 6 months after CAS. The graph depicts number of patients who did not have depressive symptoms at baseline but felt depressed after 6 months. Likewise, number of patients who had depressive symptoms at baseline but did get better or remained depressed after 6 months. (B) Graph of percentage and number of patients with and without depressive symptoms at baseline and 12 months after CAS. The graph depicts number of patients who did not have depressive symptoms at baseline but felt depressed after 12 months. Likewise, number of patients who had depressive symptoms at baseline but did get better or remained depressed after 12 months.

Fig. (6)

Changes in the frequency of depressive symptoms after 6 and 12 months in the best medical treatment group. (A) Graph of percentage and number of patients with and without depressive symptoms at baseline and 6 months after BMT. The graph depicts number of patients who did not have depressive symptoms at baseline but felt depressed after 6 months. Likewise, number of patients who had depressive symptoms at baseline but did get better or remained depressed after 6 months. (B) Graph of percentage and number of patients with and without depressive symptoms at baseline and 12 months after BMT. The graph depicts number of patients who did not have depressive symptoms at baseline but felt depressed after 12 months. Likewise, number of patients who had depressive symptoms at baseline but did get better or remained depressed after 12 months.

Fig. (7)

Results of mean SF-36v2 scores during the follow-up period in all study groups. Trend in SF-36v2 scores from baseline to 1 year. Higher scores indicate better quality of life. Significant differences (p<0.05) in scores were not observed in the CEA group during 1 year follow up period. In the CAS group SF-36v2 scores did not change during the follow up period except for bodily pain (p=0.02) where worst scores were after 12 months. In the BMT significant differences in scores were noted in 3 of 10 subscales (role physical, bodily pain and mental component summary). Compared with CAS and BMT group, CEA group patients had better scores at 6 months for 3 of the 10 SF-36v2 subscales (physical functioning, role physical and physical component summary). Plotted values at each timepoint represent means and standard deviation derived from the analysis of covariance. CEA = blue, CAS = red, BMT = grey. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this paper).