F-2-11-06
THE EFFECT OF PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY OF THE INTERNAL CAROTID ARTERY ON COGNITIVE FUNCTION AND ADL
Hiroo Yamaga-1, Hiroshi Moriwaki-2, Shinichirou Maeshima-3, Tomoaki Terada-1, Mari Nakagawa-1, Kunio Nakai-1, Toru Itakura-1, Norihiko Komai-1 (Department of Neurological Surgery, Wakayama Medical College-1, Hidaka General Hospital-2, Wakayama, Japan) (University of Sydney, Australia-3)
To examine the effects of successful percutaneous transluminal angioplasty (PTA) of the internal carotid artery (ICA) on measures of cognitive function and activities of daily living. We studied eight patients (6 men/2 women; 61-77 years old) who had angiographically-confirmed stenosis of the ICA of greater than 60%, and who had either infarction or transient ischemic attacks. Patients were evaluated with neuropsychological tests and functional independence measure (FIM) prior to and following PTA. PTA was successful in all patients, and there were no complications. The average stenosis decreased from 84.6% to 28.5% after PTA. Scores on FIM improved after PTA, and the degree of improvement was correlated with improvement in neuropsychologic tests. We suggest that PTA improves cognitive function in patients with symptomatic ICA stenoses as well as ADL.
F-2-11-07
EFFECT OF NIMODIPINE ON COGNITION AFTER CEREBRAL INFARCTION
Frank K.Sze, T.C.Sim, E.Wong, S.Cheng, J.Woo (Med & Geriatric Unit, Shatin Hos., Hong Kong)
Purpose: In previous studies, based on its neuroprotective effect, Nimodipine was given within 24-48 hours after acute ischemic stroke. Usual end-points include mortality, neurological impairment, and disability scores. However, cognitive function is also an important outcome measure. The risk of dementia has been observed to increase after ischemic stroke in population studies, suggesting further cognitive impairment after cerebral infarction. We conducted a single-blind, randomized, controlled clinical trial to determine whether Nimodipine given 7-14 days after acute cerebral infarction improved the cognitive impairment.
Methods: 100 Chinese patients with acute cerebral infarction, based on clinical and CT examination, were consecutively enrolled between D7 to D 14 after ictus from August 1994 to November 1995. After stratification according to the severity of disability as measured by BI and MMSE, and randomization, 50 patients received oral Nimodipine 90mg per day for 12 weeks, and another 50 patients were used as the control. Independent assessors administered NIH Stroke Scale, Barthel Index and the neuropsychological tests (MMSE and FOME), at baseline, 6 weeks, and 12 weeks.
Result: Patients receiving Nimodipine showed greater improvement than the control group in the change of FOME mean scores at 12 weeks from baseline (p=0.0334), and also in FOME score change across time (p=0.0283). Patients of severe disability who received Nimodipine also showed greater MMSE score change across time (p=0.0495).
Conclusion: Our study suggests that Nimodipine given 7-14 days after acute cerebral infarction for three months results in cognition improvement. Further larger and double-blind clinical trials are indicated.
