Influence of carotid atherosclerosis on the cognitive status of patients in the perioperative period

Atherosclerosis of the carotid arteries leads to global changes in structure, a decrease in the volume of gray matter and an increase in white matter, the appearance of chronic cerebral circulatory failure and cognitive dysfunction. Patients with significant stenosis require surgical treatment, which, on the one hand, can improve cognitive status and quality of life, on the other hand, is a risk factor for its aggravation in the immediate or remote postoperative period. Aim: study of the incidence of cognitive impairment and identification of risk factors for their development in patients with carotid artery atherosclerosis in the perioperative period. Materials and methods. A prospective observational single–center study included 60 patients with atherosclerosis of arteries of various localizations who underwent planned surgical treatment. In the perioperative period, cognitive status was examined using the Montreal Cognitive Assessment (MoCA). The first test was performed one day before surgery, and again on the 5th day after surgery. Results. Depending on the MoCA test result, patients were divided into two groups: Group 1 – 22 patients without cognitive impairment, average MoCA test value was 27.4±1.2 points; Group 2 – 38 patients with cognitive impairment, average MoCA test value was 21.9±3.4 points. Statistically significant differences were found between the groups for the MoCA test (p <0.001). Patients in Group 2 had reduced visual-constructive skills, speech, attention, memory, and orientation. Age is a key factor influencing cognitive status, which is due to the presence of a negative correlation of moderate strength with the total MoCA test score (r = –0.481; p<0.001), as well as with speech (r = –0.426; p<0.001), visual-constructive skills (r = –0.417; p<0.001) and memory (r = –0.283; p = 0.031). Atherosclerosis of the carotid arteries has a negative correlation with memory (r = –0.46; p<0.001), and lower extremity atherosclerosis has a positive correlation with the total MoCA score (r = 0.318; p = 0.013). After surgery, the average MoCA test score in the groups was 26.8±2.2 and 23.3±2.9 points (p<0.001), respectively. In the postoperative period, a negative relationship was established between abstract thinking and the degree of carotid artery stenosis (r = –0.503; p = 0.047), surgical intervention (r = –0.321; p = 0.029), endotracheal anesthesia (r = –0.355; p = 0.015), duration of surgery and attention (r = –0.435; p = 0.026), endotracheal anesthesia and orientation (r = –0.325; p = 0.028). Conclusion. The study found that 63% of patients with arterial atherosclerosis admitted for planned treatment were diagnosed with cognitive impairment for the first time. Multiple factors negatively affect the cognitive status of patients with carotid artery atherosclerosis.