APOE-epsilon4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy.

Autor:	Heyer EJ; Department of Neurological Surgery, Columbia University, New York, NY 10032, USA., Wilson DA, Sahlein DH, Mocco J, Williams SC, Sciacca R, Rampersad A, Komotar RJ, Zurica J, Benvenisty A, Quest DO, Todd G, Solomon RA, Connolly ES Jr
Jazyk:	angličtina
Zdroj:	Neurology [Neurology] 2005 Dec 13; Vol. 65 (11), pp. 1759-63. Date of Electronic Publication: 2005 Oct 05.
DOI:	10.1212/01.wnl.0000184579.23624.6b
Abstrakt:	Background: Between 9% and 23% of patients undergoing otherwise uncomplicated carotid endarterectomy (CEA) develop subtle cognitive decline 1 month postoperatively. The APOE-epsilon4 allele has been associated with worse outcome following stroke. Objective: To investigate the ability of APOE-epsilon4 to predict post-CEA neurocognitive dysfunction. Methods: Seventy-five patients with CEA undergoing elective CEA were prospectively recruited in this nested cohort study and demographic variables were recorded. Patients were evaluated before and 1 month after surgery with a standard battery of five neuropsychological tests. APOE genotyping was performed by restriction fragment length polymorphism analysis in all patients. Neuropsychological deficits were identified by comparing changes (before to 1 month post-operation) in individual performance on the test battery. Logistic regression was performed for APOE-epsilon4 and previously identified risk factors. Results: Twelve of 75 (16%) CEA patients possessed the APOE-epsilon4 allele. Eight of 75 (11%) patients experienced neurocognitive dysfunction on postoperative day 30. One month post-CEA, APOE-epsilon4-positive patients were more likely to be cognitively injured (42%) than APOE-epsilon4-negative patients (5%) (p = 0.002). In multivariate analysis, the presence of the APOE-epsilon4 allele increased the risk of neurocognitive dysfunction at 1 month 62-fold (62.28, 3.15 to 1229, p = 0.007). Diabetes (51.42, 1.94 to 1363, p = 0.02), and obesity (24.43, 1.41 to 422.9, p = 0.03) also predisposed to injury. Conclusion: The APOE-epsilon4 allele is a robust independent predictor of neurocognitive decline 1 month following CEA.
Databáze:	MEDLINE
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