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Cognitive function dynamics in comorbid patients after angioreconstructive interventions

https://doi.org/10.14412/2074-2711-2020-5-32-39

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Abstract

Angioreconstructive interventions are generally known to be of prophylactic value for cerebrovascular diseases (CVD). At the same time, their prognosis in comorbid patients, particularly in those with type 2 diabetes (T2D), have been insufficiently covered.

Objective: to study the impact of T2D on cognitive functions after carotid angioplasty with stenting (CAS)

Patients and methods. CAS was performed in 99 patients with chronic CVD. Group 1 consisted of 51 patients (median age, 64.5 years) without carbohydrate metabolism disorders. Group 2 included 48 patients (median age, 64 years) with T2D. Over time, all the patients underwent clinical, neurological, and neuropsychological examinations, general clinical and biochemical blood tests, duplex scanning of the brachiocephalic arteries, and magnetic resonance imaging (MRI) of the brain. Blood flow in the middle cerebral artery was monitored to assess the embolic and hemodynamic situation during a CAS procedure.

Results and discussion. The baseline frequency of neurocognitive impairment was almost the same (75%) in both groups; however, the impairment was more obvious in patients with T2D. Re-examination in Group 1 patients immediately after intervention revealed slight positive cognitive changes, while the patients with T2D showed a decrease in the indicators of mental functions. The improved ability to abstract and increase the level of generalization of functions appeared in T2D patients only 2 months after intervention. Post-CAS MRI revealed ipsilateral acute ischemic foci (AIF) in the brain substance in 11 (22%) patients of Group 1 and in 24 (50%) with concomitant T2D. Comparison of neuroimaging data with cognitive function assessments for the entire group of the examinees established deterioration in the cognitive status in patients with new ischemic brain changes detected after intervention.

Conclusion. CVD concurrent with T2D usually contributes to deterioration in the cognitive status. Angioreconstructive interventions, in particular CAS, are frequently accompanied by the identification of AIF (including «silent» ones) that can cause a transient deterioration in cognitive functions. When planning angioreconstructive interventions in patients with T2D, the question arises of predicting such risks and possible neuroprotective methods.

About the Authors

M. M. Tanashyan
Research Centre of Neurology
Russian Federation

Corresponding Member of RAS, Professor, Deputy Director for Science, Head of 1st Neurological Department

80, Volokolamskoe Shosse, Moscow 125367



K. V. Antonova
Research Centre of Neurology
Russian Federation

PhD, Senior Researcher, Scientific Advisory Department

80, Volokolamskoe Shosse, Moscow 125367



O. V. Lagoda
Research Centre of Neurology
Russian Federation

Olga V. Lagoda, PhD, Senior Researcher, 1st Neurological Department

80, Volokolamskoe Shosse, Moscow 125367



E. S. Berdnikovitch
Research Centre of Neurology
Russian Federation

PhD, head of psyhology and logopedia group

80, Volokolamskoe Shosse, Moscow 125367



R. B. Medvedev
Research Centre of Neurology
Russian Federation

MD, PhD; Researcher, 1st Neurological Department

80, Volokolamskoe Shosse, Moscow 125367



I. I. Titkova
Research Centre of Neurology
Russian Federation

Psyhologist

80, Volokolamskoe Shosse, Moscow 125367



A. V. Naminov
Research Centre of Neurology
Russian Federation

Post-graduate RCN

80, Volokolamskoe Shosse, Moscow 125367



A. V. Annushkin
Research Centre of Neurology
Russian Federation

Post-graduate RCN

80, Volokolamskoe Shosse, Moscow 125367



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For citation:


Tanashyan M.M., Antonova K.V., Lagoda O.V., Berdnikovitch E.S., Medvedev R.B., Titkova I.I., Naminov A.V., Annushkin A.V. Cognitive function dynamics in comorbid patients after angioreconstructive interventions. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(5):32-39. https://doi.org/10.14412/2074-2711-2020-5-32-39

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)