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ECPB 2017, 79(3): 44–49
https://doi.org/10.25040/ecpb2017.03.044
Research articles

Cognitive Function of Patients with Arterial Hypertension and Type 2 Diabetes Before and After Carotid Endarterectomy

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

For this research, 125 patients with hypertension and type 2 diabetes have been selected to be examined by the department of vascular surgery of Lviv regional clinical hospital from 05.19.2014 to 26.12.2016 for the purpose of carotid endarterectomy (СE). The age of the patients has ranged from 40 to 71 years (on average - 56 years). Among them - 76 (60.8 %) have been men and 49 (39.2 %) women. To evaluate the features of higher cognitive functions and their dynamics after СE, some methods of experimental-psychological, including, neuropsychological survey, have been used.

The results of the survey, using the method of ″remembering of 10 words,″ have shown a decrease in the volume of short-term and long-term memory, as well as its performance at the preoperative stage. A norm is 10 words to be remembered for 1-3 series. During work with patients, 5 series have been required, but all 10 words have been rarely reproduced. At the third stage, a statistically significant improvement in the volume of short-term memory and its productivity (p < 0.05) has been noticed there. According to the method of ″geometric figures,″ significant positive dynamics of the level of visual memory (p < 0,05) has been determined. Interpretation of the results of the digital correctional sample has shown a decrease of attention concentration (the prevalence of mistakes in the left half of the form) and mental working capacity (the number of treated lines for 6 minutes, not more than 31.41 ± 0.8 at the rate of 50), but no attention depletion has been detected. During the 2nd survey a positive dynamic of these indicators and a statistically significant increase in attention at the 3rd stage of the study (p < 0.05) have been determined.

According to the results of the neuropsychological examination using a standardized set of neuropsychological methods (SNM), patients have shown deviations from normative indices in all test blocks. The most frequent defects have been auditory memory violations (tests for repetition of words not related to the content, reproduction of the narrative), dynamic praxis (″fist-rib-palm test,″ ″play on the piano″), constructive praxis (optical-spatial disturbance in the drawing of figures with a turning of 180 °С, spatial thinking - a sample of hands), identification and playback of rhythms (errors in the evaluation of simple and complex rhythms, extra blows), a sufficiently large score in reading unit (due to a violation of the quality of the pronunciation ″noisy″ letters), gross violations of softness. Relatively fewer violations have been found in the blocks of ″account″, ″letter″ and ″thinking″.

The results of the 3rd survey has shown a significant improvement in auditory memory, expressive language, writing, visual and tactile gnosis, dynamic and constructive practical activity (p < 0.05). Statistically unreliable results in such blocks as ″rhythm,″ ″account,″ ″reading,″ ″tactile gnosis,″ and ″thinking.″ According to a survey conducted at the 3rd stage of the survey, patients have noted improvement in their condition - in 74 % of cases, deterioration - at 11 %, without changes - 15 %.

At the preoperative stage investigation of patients with pathology of carotid arteries and associated hypertension and type 2 diabetes has common non-specific features of HPV in the form of exhaustion and low productivity of intellectual-mnemonic processes. CЕ is an effective method for correction of a significant part of cognitive disorders in patients with carotid pathology and associated hypertension and type 2 diabetes.

Article recieved: 28.08.2017

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

Full text: PDF (Ukr) 0.96M

References
  1. 1. Mischenko T, Mischenko V, Zdesenko I, Nikishkova N. Clinical aspects of postnatal cognitive impairment. International Neurological Journal. 2015;7:77.
  2. 2. Akihiro M, Michihiro S, Masahiro K. Blood Pressure Variability and Cognitive Decline. Hypertension. 2014;63:1333-1338. doi.org/10.1161/HYPERTENSIONAHA.113.01819
  3. 3. De La Torre J. Cardiovascular Risk Factors Promote Brain Hypoperfusion Leading to Cognitive Decline and Dementia. Cardiovascular Psychiatry and Neurology. 2012;7:915-923. doi.org/10.1155/2012/367516
  4. 4. Guekht A, Skoog I, Korczin A, Guekht A. A randomized, double-blind, placebo-controlled trial of actovegin in patients with post stroke cognitive impairment ARTEMIDA Study Design. Dement. Geriatr. Cogn. Dis. Extra. 2013;7:459-467. doi.org/10.1159/000357122
  5. 5. Jackson D, Sandoval-Garcia C, Rocque B, Wilbrand S, Mitchell C, Hermann B et al. Cognitive deficits in symptomatic and asymptomatic carotid endarterectomy surgical candidates. Arch. Clin. Neuropsychol. 2016;3:1-7. doi.org/10.1093/arclin/acv082
  6. 6. Jellinger K. Pathogenesis and treatment of vascular cognitive impairment. Neurodegenerative Disease Management. 2014;4:471-490. doi.org/10.2217/nmt.14.37
  7. 7. Kojima D, Ogasawara K, Kobayashi M, Yoshida K, Kubo Y, Chida K. et al. Effects of uncomplicated carotid endarterectomy on cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the internal carotid artery by comparison with unoperated patients. Neurol. Res. 2016;38:580-586. doi.org/10.1080/01616412.2016.1188551
  8. 8. Majon M, Van der Graaf Y, Frank L. Hypertension and longitudinal changes in cerebral blood flow: The SMART – MR study. Annals of Neurology. 2012;71:825-833. doi.org/10.1002/ana.23554
  9. 9. Mancia G, Fagard R, Narkiewicz K. 2013 ESH/ESC Guidelines for the management of arterial hypertension of the European Society of Hypertension – the Task Forse for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J. Hypertension. 2013;31:1281-1357. doi.org/10.1097/01.hjh.0000431740.32696.cc
  10. 10. Murray MD, Lane KA, Gao S. Preservation of cognitive function with antihypertensive medication: a longitudinal analysis of community–based sample of African Americans. Arch. Intern. Med. 2002;162:2090-2096. doi.org/10.1001/archinte.162.18.2090
  11. 11. Usman R, Jamil M, Memon A. Neurocognitive improvement in patients undergoing carotid endarterectomy for atherosclerotic occlusive carotid artery disease. Ann. Vasc. Dis. 2016;9:307-311. doi.org/10.3400/avd.oa.16-00040
  12. 12. Wang T, Mei B, Zhang J. Aterosclerotic carotid stenosis and cognitive function. Clin. Neurol. Neurosurg. 2016;7:64-70. doi.org/10.1016/j.clineuro.2016.03.027
  13. 13. Wapp M , Everts R, Burren Y, Kellner-Weldon F, El-Koussy M, Wiest R. et al. Cognitive improvement in patients with carotid stenosis is independent of treatment type. Swiss. Med. Wkly. 2015;12:142-145. doi.org/10.4414/smw.2015.14226
  14. 14. Zhang H, Ma X, Chen L, Yang Y, Xu B, Zhou D. Cognitive function after carotid endarterectomy: early decline and later recovery. Turk. Neurosurg. 2016;26:833-839.


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