APOE-ε4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy

E. J. Heyer, D. A. Wilson, D. H. Sahlein, J. Mocco, S. C. Williams, R. Sciacca, A. Rampersad, Ricardo J Komotar, J. Zurica, A. Benvenisty, D. O. Quest, G. Todd, R. A. Solomon, E. S. Connolly

Research output: Contribution to journalArticle

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Abstract

Background: Between 9% and 23% of patients undergoing otherwise uncomplicated carotid endarterectomy (CEA) develop subtle cognitive decline 1 month postoperatively. The APOE-ε4 allele has been associated with worse outcome following stroke. Objective: To investigate the ability of APOE-ε4 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-ε4 and previously identified risk factors. Results: Twelve of 75 (16%) CEA patients possessed the APOE-ε4 allele. Eight of 75 (11%) patients experienced neurocognitive dysfunction on postoperative day 30. One month post-CEA, APOE-ε4-positive patients were more likely to be cognitively injured (42%) than APOE-ε4-negative patients (5%) (p = 0.002). In multivariate analysis, the presence of the APOE-ε4 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-ε4 allele is a robust independent predictor of neurocognitive decline 1 month following CEA.

Original languageEnglish
Pages (from-to)1759-1763
Number of pages5
JournalNeurology
Volume65
Issue number11
DOIs
StatePublished - Dec 1 2005
Externally publishedYes

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Carotid Endarterectomy
Alleles
Aptitude
Cognitive Dysfunction
Neuropsychological Tests
Restriction Fragment Length Polymorphisms
Cohort Studies
Multivariate Analysis
Obesity
Logistic Models
Stroke
Demography
Wounds and Injuries

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Heyer, E. J., Wilson, D. A., Sahlein, D. H., Mocco, J., Williams, S. C., Sciacca, R., ... Connolly, E. S. (2005). APOE-ε4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy. Neurology, 65(11), 1759-1763. https://doi.org/10.1212/01.wnl.0000184579.23624.6b

APOE-ε4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy. / Heyer, E. J.; Wilson, D. A.; Sahlein, D. H.; Mocco, J.; Williams, S. C.; Sciacca, R.; Rampersad, A.; Komotar, Ricardo J; Zurica, J.; Benvenisty, A.; Quest, D. O.; Todd, G.; Solomon, R. A.; Connolly, E. S.

In: Neurology, Vol. 65, No. 11, 01.12.2005, p. 1759-1763.

Research output: Contribution to journalArticle

Heyer, EJ, 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 2005, 'APOE-ε4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy', Neurology, vol. 65, no. 11, pp. 1759-1763. https://doi.org/10.1212/01.wnl.0000184579.23624.6b
Heyer EJ, Wilson DA, Sahlein DH, Mocco J, Williams SC, Sciacca R et al. APOE-ε4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy. Neurology. 2005 Dec 1;65(11):1759-1763. https://doi.org/10.1212/01.wnl.0000184579.23624.6b
Heyer, E. J. ; Wilson, D. A. ; Sahlein, D. H. ; Mocco, J. ; Williams, S. C. ; Sciacca, R. ; Rampersad, A. ; Komotar, Ricardo J ; Zurica, J. ; Benvenisty, A. ; Quest, D. O. ; Todd, G. ; Solomon, R. A. ; Connolly, E. S. / APOE-ε4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy. In: Neurology. 2005 ; Vol. 65, No. 11. pp. 1759-1763.
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abstract = "Background: Between 9{\%} and 23{\%} of patients undergoing otherwise uncomplicated carotid endarterectomy (CEA) develop subtle cognitive decline 1 month postoperatively. The APOE-ε4 allele has been associated with worse outcome following stroke. Objective: To investigate the ability of APOE-ε4 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-ε4 and previously identified risk factors. Results: Twelve of 75 (16{\%}) CEA patients possessed the APOE-ε4 allele. Eight of 75 (11{\%}) patients experienced neurocognitive dysfunction on postoperative day 30. One month post-CEA, APOE-ε4-positive patients were more likely to be cognitively injured (42{\%}) than APOE-ε4-negative patients (5{\%}) (p = 0.002). In multivariate analysis, the presence of the APOE-ε4 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-ε4 allele is a robust independent predictor of neurocognitive decline 1 month following CEA.",
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T1 - APOE-ε4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy

AU - Heyer, E. J.

AU - Wilson, D. A.

AU - Sahlein, D. H.

AU - Mocco, J.

AU - Williams, S. C.

AU - Sciacca, R.

AU - Rampersad, A.

AU - Komotar, Ricardo J

AU - Zurica, J.

AU - Benvenisty, A.

AU - Quest, D. O.

AU - Todd, G.

AU - Solomon, R. A.

AU - Connolly, E. S.

PY - 2005/12/1

Y1 - 2005/12/1

N2 - Background: Between 9% and 23% of patients undergoing otherwise uncomplicated carotid endarterectomy (CEA) develop subtle cognitive decline 1 month postoperatively. The APOE-ε4 allele has been associated with worse outcome following stroke. Objective: To investigate the ability of APOE-ε4 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-ε4 and previously identified risk factors. Results: Twelve of 75 (16%) CEA patients possessed the APOE-ε4 allele. Eight of 75 (11%) patients experienced neurocognitive dysfunction on postoperative day 30. One month post-CEA, APOE-ε4-positive patients were more likely to be cognitively injured (42%) than APOE-ε4-negative patients (5%) (p = 0.002). In multivariate analysis, the presence of the APOE-ε4 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-ε4 allele is a robust independent predictor of neurocognitive decline 1 month following CEA.

AB - Background: Between 9% and 23% of patients undergoing otherwise uncomplicated carotid endarterectomy (CEA) develop subtle cognitive decline 1 month postoperatively. The APOE-ε4 allele has been associated with worse outcome following stroke. Objective: To investigate the ability of APOE-ε4 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-ε4 and previously identified risk factors. Results: Twelve of 75 (16%) CEA patients possessed the APOE-ε4 allele. Eight of 75 (11%) patients experienced neurocognitive dysfunction on postoperative day 30. One month post-CEA, APOE-ε4-positive patients were more likely to be cognitively injured (42%) than APOE-ε4-negative patients (5%) (p = 0.002). In multivariate analysis, the presence of the APOE-ε4 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-ε4 allele is a robust independent predictor of neurocognitive decline 1 month following CEA.

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