| Objective:Cognitive impairment, a very common disorder in the elderly people, affects their quality of life severely, and even develops to dementia at its ultimate stage. So, how to identify the patients at the early stage of cognitive impairment and prevent its further development attracts more and more attentions. Besides being related with the occurrence and reoccurrence of stroke, carotid stenosis, occlusion and atheromatous plaque are also proved to contribute to cognitive impairment. This disease is usually treated by the traditional medicine administration, and by some surgical approaches, including carotid endarterectomy (CEA) and carotid artery stenting (CAS). The effect of CEA on cognitive impairment remains uncertain, and that of CAS has not been systematically studied yet. The goal of this study is to observe the change of cognitive function before and after carotid stent placement in stenosis patients and study the relationship between the mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA) of Beijing version.Methods:Totally 50 patients were enrolled in this study who were admitted in the departments of neurology in Southwest Hospital and Xinqiao Hospital from December, 2006 to October, 2007. These patients was diagnosed with carotid stenosis with cerebral digital subtraction angiography (DSA) and received CAS. Those with aphasia, acroisa, conscious disturbance, severe dysarthria or mental anomaly, or hemiplegia were excluded in this study because they can't cooperate or complete with the tests. The patients receiving CAS were neuropsychologically examined before and 1, 3 and 6 months after the operation, and were tested by the National Institutes of Health Stroke Scale (NIHSS) to identify whether stroke had recurred, and eventually compared their scores for cognitive function. MMSE, MoCA (Beijing version), Trial making A, Trial making B and Digit Symbol Shift were applied to test the cognitive function of the patients. All results were put into an Excel database, and statistically analyzed by Friedman's rank test and rank sum test with SPSS 16.0.Results:Among these 50 patients, CAS was carried out safely and successfully, and no procedural or associated complications was observed. During the 6 months of follow-up, there was no one having symptomatic stroke recurrence or death. Before the treatment,the scores of MMSE, MoCA, Digital Symbol Shift were 21.09±3.91, 15.24±4.27 and 14.03±6.61 respectively. Times for Trial making A and Trial making B were 166.03±102.04 and 467.13±143.30 s respectively. These scores were increased while the times shortened in the time points of 1, 3 and 6 months. The results were significantly different before and after the treatment (P<0.05), and the outcomes of MMSE were positively related to those of MoCA.Conclusion:Carotid artery stenting can not only effectually prevent the reoccurrence of stroke, but also significantly improve cognitive function, especially in delayed recall. Further studies are needed to confirm these preliminary observations. |
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