2021 Volume 43 Issue 4 Pages 299-305
To meaningfully define cognitive changes before and after CEA, in each patient postoperative cognitive improvement or decline was determined based on subjective cognitive assessment by a neurosurgeon and the patient’s next of kin and changes in neuropsychological test scores. As a result, the prevalence of postoperative cognitive improvement and decline was 11% and 11%, respectively. Studies using SPECT, PET, and MRI showed that CEA improves cerebral blood flow and metabolism, neurotransmitter receptor function, and white matter microarchitecture, leading to postoperative cognitive improvement. Pre-existing cerebral white matter hyperintensities on magnetic resonance imaging adversely affect cognitive improvement after CEA. These studies also demonstrated that cerebral hyperperfusion following CEA impaired cerebral metabolism, neurotransmitter receptor function, and white matter microarchitecture, resulting in postoperative cognitive decline. Cerebral microbleeds as toxic substances may leak through the blood-brain barrier that is disrupted by cerebral hyperperfusion and injure neural tissue, resulting in postoperative cognitive decline.
