Improvement and Impairment in Cognitive Function After Carotid Endarterectomy: Comparison of Objective and Subjective Assessments
Improvement and Impairment in Cognitive Function After Carotid Endarterectomy: Comparison of Objective and Subjective Assessments
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DOI：
10.2176/nmc.52.154
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发表时间：
2012-03-01
影响因子：
1.9
通讯作者：
Ogawa, Akira
中科院分区：
文献类型：
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作者：
Yoshida, Koji;Ogasawara, Kuniaki;Ogawa, Akira
对接受颈动脉内膜切除术（CEA）的患者进行前瞻性比较术后认知改善和受损的客观和主观评估。每名患者都接受了神经外科医生和患者近亲的主观认知评估，以及神经心理学测试，包括手术前7天内和手术后1至2个月内的5个测试评分。在研究的213例患者中，分别有24例（11%）、166例（78%）和23例（11%）患者被定义为术后主观认知改善、不变和受损。在所有神经心理学测试中，两项测试之间的测试评分差异（术后测试评分-术前测试评分）显著区分了术后主观认知改善、不变和受损的患者。受试者操作特征分析表明，神经心理学测试评分在检测手术后认知的主观改善和损害方面的差异的截止点分别与正常受试者对照值的平均值+ 2个标准差（SD）和平均值-2个SD相同。在27例神经心理学测试评分差异大于上界点的患者和26例神经心理学测试评分差异小于一项或多项神经心理学测试的下界点的患者中，24例（89%）和23例（88%）在手术后分别表现出主观改善和认知受损。本研究表明，神经心理学测试分数反映了术后认知变化的主观评估，并可以使用测试分数的最佳截止点检测CEA后认知的主观改善和损害。
Objective and subjective assessments of postoperative improvement and impairment in cognition were prospectively compared in patients who underwent carotid endarterectomy (CEA). Each patient underwent subjective cognitive assessment by a neurosurgeon and the patient's next of kin, and neuropsychological testing consisting of five test scores within 7 days before surgery and between 1 and 2 months after surgery. Of 213 patients studied, 24 (11%), 166 (78%), and 23 (11%) patients were defined as having subjectively improved, unchanged, and impaired cognition, respectively, following surgery. In all neuropsychological tests, differences in test scores between the two tests (postoperative test score - preoperative test score) significantly differentiated patients with subjectively improved, unchanged, and impaired cognition after surgery. Receiver operating characteristic analysis showed that the cut-off point for the differences in neuropsychological test scores in detecting subjective improvement and impairment in cognition after surgery was identical to mean + 2 standard deviations (SDs) and mean -2 SDs, respectively, of the control value obtained from normal subjects. Of 27 patients with differences in neuropsychological test scores more than the upper cut-off point and 26 patients with differences in neuropsychological test scores less than the lower cut-off point in one or more neuropsychological tests, 24 (89%) and 23 (88%) exhibited subjectively improved and impaired cognition, respectively, after surgery. The present study indicates that neuropsychological test scores reflect the subjective assessment of postoperative change in cognition, and can detect subjective improvement and impairment in cognition after CEA using the optimal cut-off points for the test scores.