London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 505 413 Behavioral disorders and post-stroke dementia Clinical interpretation of neurocognitive function following carotid endarterectomy; the di-lemma of habituation. C.J. Marley1, A. Sinnot2, D. Hodson3, J.V. Brugniaux4, K.J. New5, M.H. Lewis6, D.M. Bailey7 Neurovascular Research Laboratory, University of Glamorgan., Pontypridd, UNITED KING-DOM1, Neurovascular Research Laboratory, University of Glamorgan., Pontypridd, UNITED KINGDOM2, Neurovascular Research Laboratory, University of Glamorgan., Pontypridd, UNITED KINGDOM3, University of Glamorgan, Pontypridd, UNITED KINGDOM4, Neurovascular Re-search Laboratory, University of Glamorgan., Pontypridd, UNITED KINGDOM5, Department of Surgery, Royal Glamorgan Hospital., Llantrisant, UNITED KINGDOM6, Neurovascular Research Laboratory, University of Glamorgan., Pontypridd, UNITED KINGDOM7 Background Neurocognitive function is traditionally used to assess the effect of a vascular surgical intervention (the day before and 24 hours following surgery), such as carotid endarterectomy (CEA). Howev-er, the extent at which CEA affects neurocognitive function remains equivocal. While studies have identified improvements and thereby endorsing clinical intervention, they have consistently failed to take into account potential learning effects. Therefore, we aimed to quantify the learning effect as-sociated with the assessment of neurocognitive function and corresponding interpretive implications following CEA. Methods Neurocognitive function was assessed in 15 patients (68+/-8 years) the day before and the day fol-lowing CEA (Study 1) and in 30 healthy participants (30+/-11 years) over 2 consecutive days (Study 2). All participants completed the same battery of psychometric tests, which were randomly admin-istered and performed at a similar time of day. The battery of tests were grouped into 3 domains; i) Memory Ray Auditory Verbal Learning Test (RAVLT) and the Digit Span Test (RDF + RDB); ii) Concentration Trail Making Tests form A (TMTA) and B (TMTB) and the Digit Symbol Substitu-tion Test (DSST); and iii) Visual-motor Coordination Groove Pegboard Dexterity Test, using dom-inant (GPD) and non-dominant (GPND) hands. Results Patients recorded an improvement in the RAVLT following CEA (P < 0.05; Table 1). However, once neurocognitive function data were corrected for habituation effects identified in Study 2 (Table 1), patients in fact showed a decline in both the RAVLT and DSST (P < 0.05; Figure 1). Thus, in con-trast, CEA translated into a reduction in performance. Conclusion These findings highlight the interpretive limitations associated with the clinical assessment of neuro-cognitive function following CEA if learning effects are not taken into account. Figure 1: Uncorrected and corrected interpretation of neurocognitive function following CEA. Values are mean + SD; RAVLT, Rey auditory verbal learning test; RDF, repetition of digits for-wards; RDB, repetition of digits backwards; TMTA, trail making test A; TMTB, trail making test B; DSST, digit symbol substitution test; GPD, grooved pegboard test using dominant hand; GPND, grooved pegboard test using non-dominant hand. † = P < 0.05 vs. uncorrected comparison. Table 1: Changes in neurocognitive function. Study 1 Study 2 Tests Pre CEA Post CEA Day One Day Two Memory RDF (Score) RDB (Score) RAVLT (Score) 37 + 9 44 + 12* 49 + 9 61 + 10^ 8 + 2 8 + 2 8 + 2 8 + 2 5 + 2 6 + 2 5 + 2 6 + 2 Concentration TMTB (Score) DSST (Score) TMTA (Score) 44 + 12 42 + 14 28 + 7 25 + 7^ 105 + 44 120 + 69 58 + 20 49 + 13^ 42 + 9 43 + 11 62 +11 70 + 12^ Visual-Motor Co-ordination GPDN (Score) GPD (Score) 99 + 27 91 + 22 62 + 8 58 + 6^ 108 + 28 107 + 24 70 + 12 67 + 10^ Values are mean + SD; RAVLT, Rey auditory verbal learning test; RDF, repetition of digits for-wards; RDB, repetition of digits backwards; TMTA, trail making test A; TMTB, trail making test B; DSST, digit symbol substitution test; GPD, grooved pegboard test using dominant hand; GPND, grooved pegboard test using non-dominant hand. * = P < 0.05 vs. Pre CEA; ^ = P < 0.05 vs. previ-ous day
Karger_ESC London_2013
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