Martin Scherr1, Alexander Kunz2, Anselm Doll3, Johannes Sebastian Mutzenbach2, Erasmia Broussalis4, Hans Jürgen Bergmann5, Margarita Kirschner5, Eugen Trinka2, Monika Killer-Oberpfalzer4. 1. Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria Department of Psychiatry, Klinikum rechts der Isar, Technische Universität München, Munich, Germany TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria. 2. Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria. 3. TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. 4. Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria. 5. Neuroscience Institute, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.
Abstract
INTRODUCTION: Data on neuropsychological outcome after carotid artery stenting (CAS) remain inconsistent, furthermore cognitive outcome seems to be unpredictable in the individual case. Previous studies reporting improvement or decline might be due to ceiling and floor effects of the applied cognitive tests. We applied cognitive testing before and after CAS, avoiding the pitfall of ceiling and floor effects. METHODS: In our prospective database, we identified 72 patients free of clinical stroke with ≥70% carotid artery stenosis, who were treated with CAS. They were administered a neurocognitive test battery before and 3 months after CAS to compare cognitive performance before and after CAS. To avoid ceiling and floor effects of test performances, we additionally analysed subgroups of patients without baseline floor and ceiling cognitive performance. RESULTS: Pre-interventional to post-interventional cognitive performance improved significantly in the subtests measuring verbal episodic memory; deterioration was observed in spatial memory. The subgroups of patients without baseline floor and ceiling cognitive performance improved in measures of global cognition, verbal episodic memory (patients with left-sided CAS) and divided attention (patients with right-sided CAS); we observed no significant effects in the other domains. CONCLUSIONS: Ignoring floor and ceiling effects may underestimate the impact of CAS on cognitive performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
INTRODUCTION: Data on neuropsychological outcome after carotid artery stenting (CAS) remain inconsistent, furthermore cognitive outcome seems to be unpredictable in the individual case. Previous studies reporting improvement or decline might be due to ceiling and floor effects of the applied cognitive tests. We applied cognitive testing before and after CAS, avoiding the pitfall of ceiling and floor effects. METHODS: In our prospective database, we identified 72 patients free of clinical stroke with ≥70% carotid artery stenosis, who were treated with CAS. They were administered a neurocognitive test battery before and 3 months after CAS to compare cognitive performance before and after CAS. To avoid ceiling and floor effects of test performances, we additionally analysed subgroups of patients without baseline floor and ceiling cognitive performance. RESULTS: Pre-interventional to post-interventional cognitive performance improved significantly in the subtests measuring verbal episodic memory; deterioration was observed in spatial memory. The subgroups of patients without baseline floor and ceiling cognitive performance improved in measures of global cognition, verbal episodic memory (patients with left-sided CAS) and divided attention (patients with right-sided CAS); we observed no significant effects in the other domains. CONCLUSIONS: Ignoring floor and ceiling effects may underestimate the impact of CAS on cognitive performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Magdalena Piegza; Izabela Jaworska; Jacek Piegza; Kamil Bujak; Paweł Dębski; Aleksandra Leksowska; Piotr Gorczyca; Mariusz Gąsior; Robert Pudlo Journal: J Clin Med Date: 2022-05-27 Impact factor: 4.964