Low mini-mental status predicts mortality is asymptomatic carotid arterialstenosis

Objective: To determine whether carotid endarterectomy is superior to best medical therapy in preserving cognition, and whether low Mini-Mental State Examination (MMSE) scores predict TIA, stroke, myocardial infarction, or de ath. Methods: Subjects participating in the Asymptomatic Carotid Atheroscle rosis Study were administered the MMSE at periodic intervals. Group means w ere calculated at randomization, 1 and 3 months later, and every 6 months t hereafter. The group means were compared by treatment and over time. A prop ortional hazard regression model incorporating postrandomization MMSE score as a predictor variable was used to estimate risk of death, stroke, or oth er outcome events. Results: There was no intergroup difference in mean MMSE score during 5 years of observation. For individual patients, the relation ship between a low postrandomization score on the MMSE and increased risk o f death was significant (p less than or equal to 0.0001). Patients who expe rienced stroke after randomization also had a significant and persistent re duction in MMSE score (p less than or equal to 0.0001). Conclusions: Caroti d endarterectomy had no impact on MMSE score in this study. Patients with l ow postrandomization MMSE scores had a greater likelihood of death. Stroke reduced MMSE scores and may portend cognitive impairment. The authors recom mend the routine inclusion of cognitive testing in future clinical trials d esigned to evaluate prophylaxis or acute therapy of stroke.