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Cognition and quality of life in patients with carotid artery occlusion

A follow-up study

From the Department of Neurology (Drs. Klijn and Kappelle), Sector of Neuropsychology (Drs. Bakker and Jennekens-Schinkel), and Department of Radiology (Dr. van der Grond), University Medical Center Utrecht, and Rudolf Magnus Institute of Neuroscience, Utrecht, the Netherlands.

Address correspondence and reprint requests to Dr. F.C. Bakker, Rutgers Nisso Group, PO Box 9022, 3506 GA Utrecht, the Netherlands; e-mail: F.Bakker{at}rng.nl

Background: Little is known about long-term cognitive functioning and quality of life (QoL) in patients with symptomatic carotid artery occlusion who do not undergo revascularization surgery.

Objective: To assess the course of cognitive impairment and changes in QoL in these patients and whether impaired cerebral metabolism predicts the course of cognitive functioning.

Methods: In 73 consecutive patients with TIA or a minor stroke associated with an occlusion of the internal carotid artery (ICA), cognition and health-related QoL in a 1-year follow-up study were examined. The presence of cerebral ischemic lesions was examined by MRI; the metabolic N-acetyl aspartate/creatine ratio and the presence of lactate were measured by ¹H-MR spectroscopy in the centrum semiovale ipsilateral to the symptomatic ICA occlusion.

Results: Seventy percent of patients with a stroke and 40% of patients with a TIA were cognitively impaired. In patients with recurrent TIAs during follow-up, cognitive functioning remained at the same (impaired) level (mean impairment score: at baseline 0.7, at 1-year follow-up 0.6; p = 0.646). In patients without lactate at baseline and without recurrent symptoms during follow-up, cognitive functioning improved (mean impairment score: at baseline 1.1, at 1-year follow-up 0.7; p < 0.001). Self-perceived QoL remained affected at 12 months’ follow-up, although not to a large extent (mean SD from norm scores <1).

Conclusions: In patients with a symptomatic ICA occlusion, cognitive functioning improved within 1.5 years after the ischemic event, if no further symptoms occurred and patients had no lactate at baseline. Self-perceived QoL remained slightly affected.

Received May 13, 2003. Accepted in final form January 29, 2004.

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