Ignoring floor and ceiling effects may underestimate the effect of carotid artery stenting on cognitive performance
Ignoring floor and ceiling effects may underestimate the effect of carotid artery stenting on cognitive performance
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DOI：
10.1136/neurintsurg-2014-011612
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发表时间：
2016-07-01
影响因子：
4.8
通讯作者：
Killer-Oberpfalzer, Monika
中科院分区：
文献类型：
--
作者：
Scherr, Martin;Kunz, Alexander;Killer-Oberpfalzer, Monika
颈动脉支架植入术（CAS）后的神经心理预后数据仍然不一致，而且认知预后在个别病例中似乎是不可预测的。以前的研究报告的改善或下降可能是由于应用认知测试的上限和下限效应。我们在CAS前后进行了认知测试，避免了天花板效应和地板效应的陷阱。方法在前瞻性数据库中，我们选择了72例无临床脑卒中且颈动脉b> = 70%狭窄的患者，并给予CAS治疗。在CAS前后3个月分别进行神经认知测试，比较CAS前后的认知表现。为了避免测试表现的上限和下限效应，我们还分析了没有基线下限和上限认知表现的患者亚组。结果干预前后言语情景记忆子测试认知能力显著提高；空间记忆能力下降。没有基线底线和上限认知表现的患者亚组在整体认知、言语情景记忆（左侧CAS患者）和分散注意力（右侧CAS患者）的测量中有所改善；我们在其他领域没有观察到明显的影响。结论忽视“下限”和“上限”效应可能低估了CAS对认知能力的影响。
Introduction Data on neuropsychological outcome after carotid artery stenting (CAS) remain inconsistent, furthermore cognitive outcome seems to be unpredictable in the individual case. Previous studies reporting improvement or decline might be due to ceiling and floor effects of the applied cognitive tests. We applied cognitive testing before and after CAS, avoiding the pitfall of ceiling and floor effects.Methods In our prospective database, we identified 72 patients free of clinical stroke with >= 70% carotid artery stenosis, who were treated with CAS. They were administered a neurocognitive test battery before and 3 months after CAS to compare cognitive performance before and after CAS. To avoid ceiling and floor effects of test performances, we additionally analysed subgroups of patients without baseline floor and ceiling cognitive performance.Results Pre-interventional to post-interventional cognitive performance improved significantly in the subtests measuring verbal episodic memory; deterioration was observed in spatial memory. The subgroups of patients without baseline floor and ceiling cognitive performance improved in measures of global cognition, verbal episodic memory (patients with left-sided CAS) and divided attention (patients with right-sided CAS); we observed no significant effects in the other domains.Conclusions Ignoring floor and ceiling effects may underestimate the impact of CAS on cognitive performance.