| ObjectiveTo study the influence of different degree of carotid artery stenosis on cognitive function of patients with carotid artery stenosis,And to further explore the changes of cognitive function in patients with carotid artery stenosis after carotid endarterectomy(CEA)and standardized drug therapy.MethodsA prospective cohort of patients from May 2015 to June 2016 in Liaocheng People's Hospital vascular Department of Neurosurgery outpatients and hospital treatment of extracranial carotid artery stenosis,according to the degree of carotid artery stenosis were divided into mild(<50%),moderate(50%-70%)and severe group(>70%).Mild and asymptomatic patients with moderate stenosis group line standardized drug treatment,symptoms of patients with moderate and severe patients underwent carotid endarterectomy(CEA)treatment.Drug treatment in patients with 24 h using the Montreal cognitive assessment(MoCA)before treatment were employed to evaluate the cognitive function in the standard drug therapy after 1 months and 6 months after the assessment of cognitive function.Surgical treatment of patients before and 3 days after the brain perfusion imaging and transcranial Doppler,preoperative 24 h using Montreal cognitive assessment scale to assess cognitive function,after 1 weeks,1 months,transcranial Doppler,3 months and 6 months to assess cognitive function,6 months after surgery for brain perfusion.The MoCA score of patients with carotid stenosis before and after treatment was compared with that of the normal population(MoCA scale score =26).The MoCA scores of patients with mild and asymptomatic moderate stenosis were compared before and after the treatment with standard drugs and symptomatic moderate and severe stenosis.At the same time,preoperative and postoperative transcranial Doppler and CT cerebral perfusion were compared and analyzed.Results1.A total of 134 patients were enrolled.Before treatment,all patients with carotid artery stenosis MoCA scale score was(23.16±1.87)points,lower than the normal population mean of 26 points.The MoCA score of the severe group(19.65±2.37)was significantly lower than that in the mild group(23.83±2.36)and the moderate group(21.25±3.28),and the difference was statistically significant(P<0.05).In the form MoCA score,severe group and mild group in visuospatial ability(2.15±1.06 to 3.19±0.91),the ability to repeat(0.98±0.26 to 2.03±0.28),abstract ability(1.73±0.88 to 2.77±0.72)and delayed recall(2.28±1.36 to 3.32±1.06)was significant difference(P<0.05).2.Patients in the drug group were included in 71 cases,including 24 cases of mild stenosis and 47 cases of moderate stenosis.In the standard drug therapy after 1 months,6 months the MoCA scale score was(23.15±2.16),(23.35±2.38),compared with before treatment(22.32±2.78)points improved.The difference was statistically significant(P<0.05).3.Patients in the operation group included 63 cases,including moderate stenosis in 6 cases,severe stenosis in 57 cases.The operation was successful and the postoperative recovery was good.There were no complications such as death,cerebral hemorrhage,cerebral infarction and restenosis after operation.After 1 months,3 months,6 months MoCA scale score was(21.05±2.62),(22.16±2.78),(22.53±3.52),compared with before treatment(19.87±2.58 points)continuous improvement.The difference was statistically significant(P<0.05).The improvement of visual spatial executive ability,repetition,abstract ability and delayed recall was more obvious.The difference was statistically significant(P<0.05).The results were compared with those of 3 days before and after the operation of transcranial Doppler(TCD)and cerebral perfusion,and the results were compared with that of transcranial Doppler(TCD)at the end of the 1 week after operation,and the results were compared with the results of cerebral perfusion at the end of the 6 month after operation,1 weeks after the CEA operation,measured by transcranial Doppler(TCD)of middle cerebral artery peak velocity(SPV)(112.9±25.8 to 72.6±27.6)and pulsatility index(PI)(0.89±0.16 to 0.66±0.14)was significantly improved than that before operation(P<0.05).After the June review of perfusion CT showed preoperative ischemic cerebral blood flow(CBF)increase(54.98±7.49 to 44.28±6.56),cerebral blood volume(CBV)(2.98±0.68 to 3.25±0.54)and mean transit time(MTT)(5.16±to 6.54±1.68),peak time(TTP)(10.19±1.75 to 12.68±1.56)decreased,the difference was statistically significant(P < 0.05).ConclusionCarotid stenosis can lead to cognitive dysfunction in patients with carotid stenosis,and the more severe carotid stenosis is,the more serious the cognitive impairment is,the more obvious is the visual spatial executive ability,the ability to repeat,abstract ability and delayed recall.Standardized drug therapy can improve cognitive dysfunction caused by carotid stenosis after a certain period of time.The cognitive function of patients with carotid endarterectomy was significantly improved at 1 months after operation.Considering the reason is the improvement of cerebral perfusion. |
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