COGNITIVE TESTING IN PATIENTS UNDERGOING CAROTID ENDARTERECTOMY

Objectives: To determine by literature review the effect of carotid en darterectomy (CEA) as a modulator of cognitive function in patients wi th carotid arterial disease. Derive recommendations for standardising cognitive testing of patients with carotid arterial disease. Design an d methods: The English language literature was interrogated using a CD -ROM driven medline search using carotid endarterectomy and cognitive function as key-words between 1986-1995. These subsets were scanned an d papers of direct relevance or commonality were selected. Cited paper s prior to 1986 from these references were then sought directly. Resul ts: There are few controlled studies reporting on the effect of CEA. T here is no consensus in the literature for the effect of CEA on cognit ion or which tests should be used. Studies reporting a benefit for CEA lack a control group and fail to eliminate the effect of practice. Re ports suggesting cognitive impairment following CEA performed follow-u p tests early. Conclusions: There are many methodological problems wit h the study of cognitive function before and after carotid endarterect omy and wide disagreement in the interpretation of results. Further st udies should contain control groups, use tests resistant to practice a nd be performed when the effects of surgery and anaesthesia are passed .