RESEARCH ARTICLE Psychometric and EEG changes after carotid endarterectomy Pietro Valenti & Paola Ortelli & Antonio Zanon & Sami Schiff & Sara Montagnese & Giampietro Avruscio & Franco Del Piccolo & Daniela Mapelli & Massimo Puato & Marcello Rattazzi & Piero Amodio & Paolo Pauletto Received: 19 April 2014 /Accepted: 2 July 2014 /Published online: 18 July 2014 # Springer Science+Business Media New York 2014 Abstract The influence of carotid stenosis and its surgical treatment on brain function is still poorly defined. We there- fore performed a study to assess psychometric and quantified EEG findings after carotid endarterectomy (CEA). Sixty-nine non-demented patients (aged 72±7 years) with severe carotid stenosis (≥70 %) eligible for CEA were studied. Forty patients (group A) had unilateral stenosis, and 29 patients (group B) had bilateral stenosis. Before and 5 months after CEA all the patients were evaluated by the Trail Making Test A, the Symbol Digit Test, and spectral EEG analysis. At baseline, compared to group A, group B patients performed slowly the Trail Making Test A (Z: 1.45±1.4 vs. 0.76±1.3; p < 0.05), but not the Symbol Digit Test (Z: 0.83±1.38 vs. 0.64±1.26; p = 0.59). Altogether, the patients with at least one abnormal psychometric test were 29 % (group A: 26 %; group B: 33 %, p =0.56). The EEG did not differ significantly between patients of group A compared to group B. After CEA, psy- chometric tests improved (mean Z score from 0.73±1.12 to 0.45±1.15, p < 0.05). The improvement was similar in group A and B. The EEG mean dominant frequency improved only in group B patients and it was related to the improvement in psychometric tests (r =0.43, p =0.05). Low psychometric per- formance was detectable in about 1/ 3 of non-demented pa- tients with severe carotid stenosis. CEA improved mental performance and, in patients with severe bilateral stenosis, accelerated the EEG frequency. Keywords Carotid artery disease . Carotid endarterectomy . Electroencephalogram . Cognitive functions Introduction Carotid endarterectomy (CEA) is effective in reducing the risk of stroke and death in symptomatic patients with severe ca- rotid stenosis (>70 %) (Brott et al. 2011). On the other hand, the beneficial impact of CEA on hard events is less evident in symptomatic patients with carotid stenosis of 50–69 %, and its value is further blunted in case of stenosis lower than 50 %. In asymptomatic patients the indication for CEA is limited to those with severe stenosis (Brott et al. 2011). While the assessment of carotid surgery effectiveness is mainly based on hard outcomes such as stroke or death, the outcome of CEA on cognitive functions is less clear (Sztriha et al. 2009). Carotid stenosis has been associated to cognitive dysfunction as far as memory, language, and attentive functions is con- cerned (King et al. 1977; Kelly et al. 1980). Some authors suggested that such alterations depend on brain hypoperfusion (Madl et al. 1994) whereas others suggest that they depend only on intracranial brain vessel atherosclerosis (Benke et al. 1991). In the first case, CEA would improve cerebral func- tions after restoring cerebral blood flow. In the latter, this Piero Amodio and Paolo Pauletto Joint Seniorship P. Valenti : M. Rattazzi : P. Pauletto Medicina Interna I, Ospedale Ca’ Foncello, Via Ospedale, 31100 Treviso, Italy P. Ortelli : S. Schiff : S. Montagnese : P. Amodio CIRMANMEC, Università di Padova, Padova, Italy A. Zanon : M. Puato DISCOG, Università di Padova, Padova, Italy S. Schiff : S. Montagnese : F. Del Piccolo : D. Mapelli : M. Rattazzi : P. Amodio : P. Pauletto (*) DIMED, Università di Padova, Padova, Italy e-mail: paolo.pauletto@unipd.it G. Avruscio Angiologia, Azienda Ospedaliera di Padova, Padova, Italy D. Mapelli Dipartimento di Psicologia Generale, Università di Padova, Padova, Italy Metab Brain Dis (2015) 30:99–105 DOI 10.1007/s11011-014-9589-1