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J Neurol Surg A Cent Eur Neurosurg 2024; 85(03): 254-261
DOI: 10.1055/s-0043-1769004
Original Article

The Early Postoperative Course of Cognitive Function and Preoperative Cerebrovascular Reserve

Masashi Ikota
1   Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Saitama-City, Saitama, Japan
,
Mami Ishikawa 
1   Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Saitama-City, Saitama, Japan
,
Gen Kusaka
1   Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Saitama-City, Saitama, Japan
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Abstract

Background Patients with severe steno-occlusive disease of a main cerebral artery without causative lesions on magnetic resonance imaging (MRI) often develop cognitive impairment. However, the effects of revascularization surgery and the source of the cognitive impairment remain unclear. Therefore, we investigated the early postoperative course of cognitive function and its association with cerebral blood flow (CBF), cerebrovascular reserve (CVR), white matter disease (WMD), lacunar infarction, and cerebrovascular risk factors.

Methods Cognitive function was examined using neurobehavioral cognitive status examination (COGNISTAT) in 52 patients with steno-occlusive disease of a main cerebral artery before and at 6 months after superficial temporal artery–middle cerebral artery (STA–MCA) anastomosis. We examined how cognition changed before and at 1, 3, and 6 months after STA–MCA anastomosis in 27 of 52 patients. CVR and CBF were calculated from 123I-N-isopropyl-p-iodoamphetamine single photon emission computed tomography, in addition to other cerebrovascular risk factors in 34 of 52 patients. Cerebral infarction and WMD (periventricular hyperintensity [PVH] and deep subcortical white matter hyperintensity) were also evaluated preoperatively by MRI.

Results COGNISTAT scores improved at 1 month after STA–MCA anastomosis in patients with severe steno-occlusive disease of a main cerebral artery. Multiple stepwise regression analysis revealed that CVR (regression coefficient = –2.237, p = 0.0020) and PVH (regression coefficient = 2.364, p = 0.0029) were the best predictors of postoperative improvement in COGNISTAT scores (R 2 = 0.415; p = 0.0017).

Conclusion Cognitive function improves in relation to preoperative CVR and PVH early after STA–MCA anastomosis in patients with steno-occlusive disease of a main cerebral artery.

Keywords

cognition - cerebrovascular reserve - cerebral blood flow - regression correlation


Publication History

Received: 05 August 2022

Accepted: 09 January 2023

Article published online:
28 July 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Demarin V, Zavoreo I, Kes VB. Carotid artery disease and cognitive impairment. J Neurol Sci 2012; 322 (1–2): 107-111
    CrossrefPubMedGoogle Scholar
  • 2 Fearn SJ, Hutchinson S, Riding G, Hill-Wilson G, Wesnes K, McCollum CN. Carotid endarterectomy improves cognitive function in patients with exhausted cerebrovascular reserve. Eur J Vasc Endovasc Surg 2003; 26 (05) 529-536
    CrossrefPubMedGoogle Scholar
  • 3 Ishikawa M, Saito H, Yamaguro T. et al. Cognitive impairment and neurovascular function in patients with severe steno-occlusive disease of a main cerebral artery. J Neurol Sci 2016; 361 (02) 43-48
    CrossrefPubMedGoogle Scholar
  • 4 Kishikawa K, Kamouchi M, Okada Y, Inoue T, Ibayashi S, Iida M. Effects of carotid endarterectomy on cerebral blood flow and neuropsychological test performance in patients with high-grade carotid stenosis. J Neurol Sci 2003; 213 (1–2): 19-24
    CrossrefPubMedGoogle Scholar
  • 5 Sasoh M, Ogasawara K, Kuroda K. et al. Effects of EC-IC bypass surgery on cognitive impairment in patients with hemodynamic cerebral ischemia. Surg Neurol 2003; 59 (06) 455-460 , discussion 460–463
    CrossrefPubMedGoogle Scholar
  • 6 Iadecola C. The pathobiology of vascular dementia. Neuron 2013; 80 (04) 844-866
    CrossrefPubMedGoogle Scholar
  • 7 Dong Y, Teoh HL, Chan BP. et al. Changes in cerebral hemodynamic and cognitive parameters after external carotid-internal carotid bypass surgery in patients with severe steno-occlusive disease: a pilot study. J Neurol Sci 2012; 322 (1–2): 112-116
    CrossrefPubMedGoogle Scholar
  • 8 Fiedler J, Přibáň V, Skoda O, Schenk I, Schenková V, Poláková S. Cognitive outcome after EC-IC bypass surgery in hemodynamic cerebral ischemia. Acta Neurochir (Wien) 2011; 153 (06) 1303-1311 , discussion 1311–1312
    CrossrefPubMedGoogle Scholar
  • 9 Ishikawa M, Kusaka G, Terao S, Nagai M, Tanaka Y, Naritaka H. Improvement of neurovascular function and cognitive impairment after STA-MCA anastomosis. J Neurol Sci 2017; 373 (02) 201-207
    CrossrefPubMedGoogle Scholar
  • 10 Kolb B, Fadel H, Rajah G, Saber H, Luqman A, Rangel-Castilla L. Effect of revascularization on cognitive outcomes in intracranial steno-occlusive disease: a systematic review. Neurosurg Focus 2019; 46 (02) E14
    CrossrefPubMedGoogle Scholar
  • 11 Barnett HJM, Taylor DW, Haynes RB. et al; North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325 (07) 445-453
    CrossrefPubMedGoogle Scholar
  • 12 Shinohara Y, Tohgi H, Hirai S. et al. Effect of the Ca antagonist nilvadipine on stroke occurrence or recurrence and extension of asymptomatic cerebral infarction in hypertensive patients with or without history of stroke (PICA Study). 1. Design and results at enrollment. Cerebrovasc Dis 2007; 24 (2–3): 202-209
    CrossrefPubMedGoogle Scholar
  • 13 Matsuda O, Nakatani M. Manual for Japanese version of the neurobehavioral cognitive status examination (COGNISTAT). Tokyo: World Planning; 2001
    Google Scholar
  • 14 Almubark BM, Cattani A, Floccia C. Translation, cultural adaptation, and validation of Cognistat for its use in Arabic-speaking population with acquired brain injury. Eur J Phys Rehabil Med 2019; 55 (05) 595-604
    CrossrefPubMedGoogle Scholar
  • 15 Kawamura Y, Ashizaki M, Saida S, Sugimoto H. Usefulness of rate of increase in SPECT counts in one-day method of N-isopropyl-4-iodoamphetamine [123I] SPECT studies at rest and after acetazolamide challenge using a method for estimating time-dependent distribution at rest. Ann Nucl Med 2008; 22 (05) 457-463
    CrossrefPubMedGoogle Scholar
  • 16 Okamoto K, Ushijima Y, Okuyama C, Nakamura T, Nishimura T. Measurement of cerebral blood flow using graph plot analysis and I-123 iodoamphetamine. Clin Nucl Med 2002; 27 (03) 191-196
    CrossrefPubMedGoogle Scholar
  • 17 Powers WJ, Clarke WR, Grubb Jr RL, Videen TO, Adams Jr HP, Derdeyn CP. COSS Investigators. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA 2011; 306 (18) 1983-1992
    CrossrefPubMedGoogle Scholar
  • 18 Jussen D, Zdunczyk A, Schmidt S. et al. Motor plasticity after extra-intracranial bypass surgery in occlusive cerebrovascular disease. Neurology 2016; 87 (01) 27-35
    CrossrefPubMedGoogle Scholar
  • 19 Wessels L, Hecht N, Vajkoczy P. Patients receiving extracranial to intracranial bypass for atherosclerotic vessel occlusion today differ significantly from the COSS Population. Stroke 2021; 52 (10) e599-e604
    CrossrefPubMedGoogle Scholar
  • 20 Kuroda S, Kamiyama H, Abe H, Houkin K, Isobe M, Mitsumori K. Acetazolamide test in detecting reduced cerebral perfusion reserve and predicting long-term prognosis in patients with internal carotid artery occlusion. Neurosurgery 1993; 32 (06) 912-918 , discussion 918–919
    CrossrefPubMedGoogle Scholar
  • 21 Kuroda S, Shiga T, Houkin K. et al. Cerebral oxygen metabolism and neuronal integrity in patients with impaired vasoreactivity attributable to occlusive carotid artery disease. Stroke 2006; 37 (02) 393-398
    CrossrefPubMedGoogle Scholar
  • 22 Drane DL, Osato SS. Using the neurobehavioral cognitive status examination as a screening measure for older adults. Arch Clin Neuropsychol 1997; 12 (02) 139-143
    CrossrefPubMedGoogle Scholar
  • 23 Tsuruoka Y, Takahashi M, Suzuki M, Sato K, Shirayama Y. Utility of the Neurobehavioral Cognitive Status Examination (COGNISTAT) in differentiating between depressive states in late-life depression and late-onset Alzheimer's disease: a preliminary study. Ann Gen Psychiatry 2016; 15: 3
    CrossrefPubMedGoogle Scholar
  • 24 Likitjaroen Y, Suwanwela NC, Phanthumchinda K. Vasoreactivity induced by acetazolamide in patients with vascular dementia versus Alzheimer's disease. J Neurol Sci 2009; 283 (1-2): 32-35
    CrossrefPubMedGoogle Scholar