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. 2014 Jun 24;4(2):132–148. doi: 10.1159/000362921

Table 2.

Studies on neurocognitive outcome after CEA

Reference Patients in follow-up Control group Follow-up period NCF after CEA Control for effect previous stroke on NCF Cognitive domains and tests
Bossema et al. [34], 2007a

  • 45 CEA (20 lCEA and 25 rCEA)

  • Asympt. + sympt. (lCEA: 45%, rCEA: 76%)

 25 healthy (similar education, age, and hand dominance) 3 months

  • No interactions between time and group. Both groups improved equally

  • No difference between patients and controls on reliable changes after CEA

 No stroke included

  • Dichotic Listening Test

  • Finger Tapping Test

  • Motor Planning Test / Verbal

  • Fluency Test (COWAT + category)

  • Doors Test
Saito et al. [39], 2007c

  • 55 CEA

  • Asympt. + sympt. (62%)

 20 patients (neck clipping through craniotomy) 1 month Impairment: 11% in one or more cognitive domains (only impairments were assessed)

  • 44% stroke

  • No symptoms <1 month

  • No significant differences between groups (impairment/no impairment) for symptomatic status

  • WAIS-R (verbal IQ + performance IQ)

  • WMS

  • CFT-R (copy + recall)
Falken-sammer et al. [43], 2008c

  • 19 CEA at 7–10 days

  • 16 CEA at 6 months

  • Asympt.

 No 7–10 days, 6 months

  • Overall improvement at 7–10 days and 6 months. 3 patients showed decline (1 with reliable change indices = 6%) Significant improvement in digit symbol, verbal memory.

  • Conversely, there was a significant decline on one test assessing processing speed at 6 months (word reading in SCWT)

 NA

  • Fine motor coordination: GP

  • Expressive language: COWAT, category fluency

  • Verbal memory: RAVLT

  • Mental status screen: MMSE

  • Estimated premorbid verbal IQ: ART

  • Processing speed/attention/executive function: Digit Span and Digit Symbol (WAIS-R), TMT (A and B), SCWT, D-KEF Sorting Test
Hirooka et al. [38], 2008c

  • 158 CEA

  • Asympt. + sympt. (70%)

 No 1 month Impairment: 11% on 1 or more of 5 domains (only impairments were assessed)

  • 51% stroke

  • No control for stroke or symptomatic status

  • WAIS-R (verbal IQ + performance IQ)

  • WMS

  • CFT-R (copy + recall)
Chida et al. [27], 2009a

  • 60 CEA

  • Asympt + Sympt (62%)

  • 44 patients (neck clipping through craniotomy;

  • historical control)

 1 month Impairment: 13% in one or more of 5 domains (only impairments were assessed)

  • 43% stroke

  • No significant differences between groups (impairment/no impairment) for symptomatic status

  • WAIS-R (verbal IQ + performance IQ)

  • WMS

  • CFT-R (copy + recall)
Soinne et al. [31], 2009b

  • 44 CEA

  • Asympt. + sympt. (48%)

  • 22 healthy

  • Matched (sex, age, education, and social class)

 100 days

  • Equal improvement for CEA and controls

  • At 100 days:

  • Impairment: CEA, 5 patients (11%) vs. controls, 0%

  • On the domain level: attention 48% of CEA vs. 18% of controls had impairment (significant), motor dexterity, 32% of patients vs. 18% of controls (NS)

  • 15% minor stroke

  • No control for stroke on NCF

  • Language: BNT

  • Verbal memory and learning:

  • RAVLT

  • Immediate verbal memory: WAIS-R

  • Digit Span –F and B

  • Verbal fluency: word and category naming

  • Visual memory: CFT-R – Visual

  • Design Learning Test

  • Immediate visual memory: Corsi

  • Blocks F and B

  • Attention: Letter Cancellation Task, TMT (A)

  • Executive function: Stroop Test, TMT (B)

  • Motor dexterity: Purdue Pegboard
Yocum et al. [32] (2009)a 149 CEA Asympt. + sympt. (no percentages are given) 60 patients (lumbar spine surgery) 1 month At 1 month: moderate to severe cognitive deterioration: 16% (10% severe, 6% moderate) No information is given about symptoms

  • Verbal function: BNT

  • Verbal fluency: COWAT

  • Visuospatial construction: CFT-R (copy)

  • Visuospatial memory: CFT-R (recall)

  • Complex conceptual switching: TMT (B)

  • Attention: TMT (A)

  • Verbal learning and memory: HVLT or BSRT
Chida et al. [28], 2010a

  • 79 CEA

  • Asympt. + sympt. (59%)

 70 healthy 1 month Improvement: 9% in one or more of 5 domains (only improvements were assessed)

  • 19% stroke No symptoms <2 weeks

  • No significant differences between groups (improvement/no improvement) for symptomatic status or stroke

  • WAIS-R (verbal IQ + performance IQ)

  • WMS

  • CFT-R (copy + recall)
Czerny et al. [36], 2010b

  • 25 CEA

  • Asympt. + sympt. (60%)

  • 25 healthy

  • Matched (age and sex)

 1 and 5 years

  • Improvement for patient group at 1 and 5 years on the NCT

  • No changes on MMSE

 No stroke included

  • MMSE

  • NCT
Gigante et al. [33], 2011a

  • 127 CEA

  • Asympt. + sympt. (4%)

 71 patients (lumbar laminectomy/similar age and education) 30 days

  • At 30 days:

  • Moderate to severe deterioration: 6%

 No information is given about the type of symptoms in the symptomatic patients

  • Verbal function: BNT

  • Verbal fluency: COWAT Visuospatial construction: CFT-R (copy)

  • Visuospatial memory: CFT-R (recall)

  • Complex conceptual switching: TMT (B)

  • Attention: TMT (A)

  • Verbal learning and memory: HVLT or BSRT

  • Manual dexterity: GP
Baracchini et al. [35], 2012b 145 CEA (divided into 2 groups: 70 asympt. and 75 sympt.) 68 patients (laparoscopic cholecystectomy) Matched (age and sex) 3 and 12 months

  • Symptomatic: cognitive performance (MMSE and MOCA) improved

  • Asymptomatics: no changes (though baseline differences: symptomatics were significantly impaired at baseline, asymptomatics not)

  • No severe stroke 35% of symptomatic group had minor stroke

  • No control for minor stroke on NCF

  • MMSE

  • MOCA
Ghogawala et al. [37], 2012c

  • 23 CEA (at 1 month) 20 CEA at 6 months 19 CEA at 12 months

  • Asympt. + sympt. (21%)

 No 1, 6, and 12 months

  • At 1 month:

  • Improvement: 30%

  • Deterioration: 30–40% on TMT (A and B) and HVLT

  • At 12 months: significant improvement for all tests Improvement: 60%

 No stroke included

  • Attention: TMT (A)

  • Executive functioning: TMT (B)

  • Verbal fluency: COWAT

  • Verbal learning and memory: HVLT
Nanba et al. [30], 2012a

  • 70 CEA

  • Asympt. + sympt. (71%)

 44 patients (neck clipping through craniotomy; historical control) 1 month Deterioration: 13% in one or more of 5 domains (only impairments were assessed)

  • 31% stroke

  • No symptoms <2 weeks

  • No significant differences between groups (impairment/no impairment) for symptomatic status

  • WAIS-R (verbal IQ + performance IQ)

  • WMS

  • CFT-R (copy + recall)
Yamashita et al. [29], 2012a

  • 140 CEA

  • Asympt. + sympt. (69%)

 70 healthy (historical control) 1 month Improvement in 10% of patients in one or more of 5 domains (only improvements were assessed)

  • No symptoms <2 weeks

  • No significant differences between groups (improvement/no improvement) for symptomatic status

  • WAIS-R (verbal IQ + performance IQ)

  • WMS

  • CFT-R (copy + recall)
Yosida et al. [40], 2012c

  • 213 CEA

  • Asympt. + sympt. (65%)

 40 healthy 1–2 months

  • Improvement: 13%

  • Deterioration: 12%

  • No symptoms <2 weeks

  • No control for stroke on NCF

  • WAIS-R (verbal IQ + performance IQ)

  • WMS

  • CFT-R (copy + recall)
Inoue et al. [41], 2013c

  • 81 CEA

  • Asympt. + sympt. (54%)

 No 6 months Significant improvement for all scores (VIQ, PIQ, WMS-memory and WMS-attention) No information about stroke tendency of positive effect of symptomatic status on progress

  • WAIS-R (verbal IQ + performance IQ)

  • WMS (memory + attention)
Saito et al. [26], 2013a

  • 100 CEA

  • Asympt. + sympt. (64%)

 40 healthy (historical control) 1 month

  • Improvement: 10%

  • Impairment: 10% in one or more of the 5 cognitive scores

  • No symptoms <2 weeks

  • No significant differences between groups (improvement/deterioration) for symptomatic status

  • WAIS-R (verbal IQ + performance IQ)

  • WMS

  • CFT-R (copy + recall)
Takaiwa et al. [42], 2013c

  • 15 CEA

  • Asympt.

 No 3 months

  • Improvements in immediate memory, attention, total scale of the RBANS, and 2 subtests of WAIS-R

  • Improvement: 30%

  • Deterioration: 7% in RBANS and WAIS-R subtest scores

 NA

  • RBANS (immediate memory, visuospatial construction, language, attention, delayed memory, and total score) WAIS-R 2 subtests (information and picture completion)

  • ART

Author names in bold means the study was reviewed in the Results section. NA = Not applicable; WAIS-R = Wechsler Adult Intelligence Scale Revised; WMS = Wechsler Memory Scale; CFT-R = Rey Complex Figure Test; RAVLT = Rey Auditory Verbal Learning Test; HVLT = Hopkins Verbal Learning Test; BSRT = Buschke Selective Reminding Test; RBANS = Repeatable Battery for the Assessment of Neuropsychological Status; MOCA = Montreal Cognitive Assessment; GP = Grooved Pegboard; NCT = Number Connection Test; TMT = Trail Making Test; COWAT = Controlled Oral Word Association Test; BNT = Boston Naming Test; ART = Adult Reading Test; SCWT = Stroop Color and Word Test; D-KEF = Delis-Kaplan Executive Function.

a

Using statistical methods to compare the patient and control group.

b

Calculating differences for the patient and control group over time separately, the control group contains more than half the number of the patient group.

c

No control group, or calculating differences for the patient and control group over time separately, with a control group that contains less than half the number of the patient group.