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Ignoring floor and ceiling effects may underestimate the effect of carotid artery stenting on cognitive performance
  1. Martin Scherr1,2,3,6,
  2. Alexander Kunz1,6,
  3. Anselm Doll3,
  4. Johannes Sebastian Mutzenbach1,6,
  5. Erasmia Broussalis1,4,6,
  6. Hans Jürgen Bergmann5,6,
  7. Margarita Kirschner5,6,
  8. Eugen Trinka1,6,
  9. Monika Killer-Oberpfalzer1,4,6
  1. 1Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
  2. 2Department of Psychiatry, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
  3. 3TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
  4. 4Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
  5. 5Neuroscience Institute, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
  6. 6Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
  1. Correspondence to Dr Martin Scherr, Universitätsklinik für Neurologie, Paracelsus Medical University, Ignaz Harrer Straße 79, Salzburg 5020, Austria; martin_scherr{at}hotmail.com

Abstract

Introduction Data on neuropsychological outcome after carotid artery stenting (CAS) remain inconsistent, furthermore cognitive outcome seems to be unpredictable in the individual case. Previous studies reporting improvement or decline might be due to ceiling and floor effects of the applied cognitive tests. We applied cognitive testing before and after CAS, avoiding the pitfall of ceiling and floor effects.

Methods In our prospective database, we identified 72 patients free of clinical stroke with ≥70% carotid artery stenosis, who were treated with CAS. They were administered a neurocognitive test battery before and 3 months after CAS to compare cognitive performance before and after CAS. To avoid ceiling and floor effects of test performances, we additionally analysed subgroups of patients without baseline floor and ceiling cognitive performance.

Results Pre-interventional to post-interventional cognitive performance improved significantly in the subtests measuring verbal episodic memory; deterioration was observed in spatial memory. The subgroups of patients without baseline floor and ceiling cognitive performance improved in measures of global cognition, verbal episodic memory (patients with left-sided CAS) and divided attention (patients with right-sided CAS); we observed no significant effects in the other domains.

Conclusions Ignoring floor and ceiling effects may underestimate the impact of CAS on cognitive performance.

  • Angiography
  • Atherosclerosis

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