Cognition and quality of life in patients with carotid artery occlusion

Background: Little is known about long-term cognitive functioning and quality of life (QoL) in patients with symptomatic carotid artery occlusion who do not undergo revascularization surgery. Objective: To assess the course of cognitive impairment and changes in QoL in these patients and whether impaired cerebral metabolism predicts the course of cognitive functioning. Methods: In 73 consecutive patients with TIA or a minor stroke associated with an occlusion of the internal carotid artery (ICA), cognition and health-related QoL in a 1-year follow-up study were examined. The presence of cerebral ischemic lesions was examined by MRI; the metabolic N-acetyl aspartate/creatine ratio and the presence of lactate were measured by ¹H-MR spectroscopy in the centrum semiovale ipsilateral to the symptomatic ICA occlusion. Results: Seventy percent of patients with a stroke and 40% of patients with a TIA were cognitively impaired. In patients with recurrent TIAs during follow-up, cognitive functioning remained at the same (impaired) level (mean impairment score: at baseline 0.7, at 1-year follow-up 0.6; p = 0.646). In patients without lactate at baseline and without recurrent symptoms during follow-up, cognitive functioning improved (mean impairment score: at baseline 1.1, at 1-year follow-up 0.7; p < 0.001). Self-perceived QoL remained affected at 12 months' follow-up, although not to a large extent (mean SD from norm scores <1). Conclusions: In patients with a symptomatic ICA occlusion, cognitive functioning improved within 1.5 years after the ischemic event, if no further symptoms occurred and patients had no lactate at baseline. Self-perceived QoL remained slightly affected.