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ECPB 2017, 78(2): 37–43
https://doi.org/10.25040/ecpb2017.02.037
Research articles

Features of cognitive Impairment in Patients with hypertensive disorders and carotid Arteries, depending on the affected side Carotid before and after Surgery

O. DIDENKO, I. KOBZA, O. YAVORSKYI
Abstract

The estimate of cognitive features (CF) and their dynamics after carotid endarterectomy (CE) in 118 patients with hypertension and carotid arteriespathology. Applied experimental psychological and neuropsychological examination methods. The examination was conducted 2 days before surgery and 6 months after surgery. CE was provided under local anesthesia. For the surgery, the patients were divided into three groups: patients with carotid stenosis on the right side (group «R»), patients with the carotid stenosis on the left side (group «L») and patients with carotid stenosis on both sides (group «B» ). In group «R» on the preoperative stage, neuropsychological dysfunction syndrome was accounting for the combination of right temporal (violation of perception and playing rhythms, visual memory), parietal areas (optical-spatial disorders), parietal, occipital structures (light violations visual gnosis). Decreased volumes of short-term memory, concentration and mental performance. Patients of the «L» at this stage included dominant disorders: auditory memory and dynamic praxis stereognosis of the right hand, constructive activity, decreased productivity and concentration. The preserved remained dynamic and praxis stereognosis of the left hand, rhythm identification and reproduction. In group «B» there were all the violations, practically in all neuropsychological tests. Postoperative examination results in the «R» showed a statistically significant improvement in the auditory of memory (p < 0.05), and dynamic praxis stereognosis of the left arm (p < 0.05), visual memory (p < 0.05), performance (p < 0.001) and concentration (p < 0.05). There was no reduction in rhythm disorders of perception, thinking and constructive praxis. At this stage in the «L» in the first place were performed regression disorders expressive language (p < 0.05), writing (p < 0.05), constructive praxis (p < 0.05), auditory memory (p < 0, 01), spatial disturbances (p < 0.05), and increased productivity attention (p < 0.05). There were no significant improvement of visual memory, visual and tactile gnosis, praxis poses. Patients of the «B» is less visible dynamics СF had a significant improvement of visual gnosis (p < 0.05) and productivity attention (p < 0.01). Negative dynamics were observed in the block «rhythm». KE caused the nonspecific improvement of the functioning of deep brain structures that gave it the positive dynamics of the intellectual and the mental performance in patients with hypertensive disorders and carotid arteries. For patients with unilateral localization of the pathological process in the preoperative phase, the characteristic neuropsychological symptoms that meet the blood supply to the affected area of the carotid artery. In bilateral carotid lesions, there were changes in the left and right hemispheres of the brain. In remote postoperative period, regardless of lesion localization, there was the most significant functional recovery associated with vascularization area corresponding with the stereognosis artery. In bilateral carotid disease symptoms that were regressed, the right hemisphere was slower and less pronounced than the left.

Keywords: cognitive function, carotid endarterectomy, hypertension, carotid stenosis

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