Effects of Carotid Endarterectomy on the Dynamics of Cognitive Impairments in Patients with Atherosclerotic Stenosis of the Carotid Arteries

The clinical and neurochemical characteristics of non-dementia cognitive disorders were studied in 102 patients with atherosclerotic carotid sclerosis, with assessment of their dynamics after carotid endarterectomy (CEAE). Mild cognitive disorders were seen in 37 patients (36.3 %) and moderate cognitive disorders in 36 patients (35.3 %). Moderate cognitive impairments were significantly more common in patients with symptoms of carotid stenosis, dominated by structural changes in the brain on neuroimaging (leukoaraiosis and infarcts); unstable atherosclerotic plaques, with a predominance of the hypodense component, were also more frequent. This suggests that cognitive dysfunction in patients with atherosclerotic carotid stenosis results not only from decreased perfusion, but also from arterio-arterial microembolism. CEAE was found to have favorable effects on cognitive functions. Positive changes were marked in patients with asymptomatic carotid stenosis. However, CEAE could also have adverse influences on cognitive functions in patients with moderate cognitive disorders of dysmnestic type and symptoms of carotid stenosis.