{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:50:50Z","timestamp":1786125050981,"version":"build-2736575974"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NEUROSURGERY","NEUROS"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Vascular cognitive decline is critically important in the course of atherosclerosis and stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To explore the hypothesis that carotid endarterectomy (CEA) by removing an unstable plaque may slow the course of vascular cognitive decline in both symptomatic and asymptomatic patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients with clinically significant (&gt;60%) carotid stenosis were studied preop and 1 yr post-CEA for clinical symptoms, vascular cognitive decline, instability of carotid plaque\u2014presence of microemboli, brain white matter changes, and medical risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Forty-six percent were classically symptomatic. All patients showed vascular cognitive decline at presentation which correlated with degree of plaque instability. Significant white matter hyperintensity changes (48.7%) and cerebral emboli (25%) were also seen at baseline in both classically symptomatic and asymptomatic. One year after CEA, both groups showed no decline in cognitive function and significant improvement in 2 tests (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .028 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .013). Brain white matter hyperintensities were unchanged. Microemboli were reduced but remained present (17.86%). Improvement was predicted by the presence of hypertension (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .001), or less advanced cognitive decline preoperatively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>This study demonstrates the importance of vascular cognitive decline in atherosclerotic disease. This is a function of the degree of instability of the atherosclerotic plaque more than the presence of stroke symptoms. It further suggests that atherosclerotic vascular cognitive decline need not be inevitable, and may be modified by treating hypertension and removal of the unstable plaque. This highlights the need for continued research on the cognitive effects of cerebrovascular disease and the synergistic benefits of intensive medical and surgical therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyx173","type":"journal-article","created":{"date-parts":[[2017,3,14]],"date-time":"2017-03-14T00:09:54Z","timestamp":1489450194000},"page":"322-328","source":"Crossref","is-referenced-by-count":26,"title":["The Preservation of Cognition 1 Year After Carotid Endarterectomy in Patients With Prior Cognitive Decline"],"prefix":"10.1227","volume":"82","author":[{"given":"Robert J","family":"Dempsey","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daren C","family":"Jackson","sequence":"additional","affiliation":[{"name":"Wisconsin Surgical Outcomes Center Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie M","family":"Wilbrand","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol C","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Medicine Division, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara E","family":"Berman","sequence":"additional","affiliation":[{"name":"Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sterling C","family":"Johnson","sequence":"additional","affiliation":[{"name":"Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirvedh H","family":"Meshram","sequence":"additional","affiliation":[{"name":"Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin"},{"name":"Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomy","family":"Varghese","sequence":"additional","affiliation":[{"name":"Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce P","family":"Hermann","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Wisconsin School of Medicine and Public Health, Centennial Building, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,3]]},"reference":[{"key":"bib1-20231011","article-title":"Carotid Atherosclerotic plaque instability and cognition determined by ultrasound-measured plaque strain in asymptomatic patients with significant stenosis","author":"Dempsey","year":"2017","journal-title":"J\u00a0Neurosurg"},{"issue":"2","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1227\/01.NEU.0000371730.11404.36","article-title":"A review of carotid atherosclerosis and vascular cognitive decline: a new understanding of the keys to symptomology","volume":"67","author":"Dempsey","year":"2010","journal-title":"Neurosurgery"},{"issue":"13","key":"bib3-20231011","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1056\/NEJMoa022066","article-title":"Silent brain infarcts and the risk of dementia and cognitive decline","volume":"348","author":"Vermeer","year":"2003","journal-title":"N Engl J Med"},{"issue":"11","key":"bib4-20231011","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1093\/aje\/kwm085","article-title":"Transitions to mild cognitive impair-ments, dementia, and death: findings from the Nun Study","volume":"165","author":"Tyas","year":"2007","journal-title":"Am J Epidemiol"},{"issue":"3","key":"bib5-20231011","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1159\/000071128","article-title":"Annual incidence of first silent stroke in the United States: a preliminary estimate","volume":"16","author":"Leary","year":"2003","journal-title":"Cerebrovasc Dis"},{"issue":"1","key":"bib6-20231011","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/arclin\/acv082","article-title":"Cognitive deficits in symptomatic and asymptomatic carotid endarterectomy surgical candidates","volume":"31","author":"Jackson","year":"2016","journal-title":"Arch Clin Neuropsychol"},{"issue":"9","key":"bib7-20231011","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.nicl.2015.08.011","article-title":"The relationship between carotid artery plaque stability and white matter ischemic injury","author":"Berman","year":"2015","journal-title":"Neuroimage Clin"},{"issue":"4","key":"bib8-20231011","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.ultrasmedbio.2015.11.025","article-title":"Classification of symptomatic and asymptomatic patients with and without cognitive decline using non-invasive carotid plaque strain indices as biomarkers","volume":"42","author":"Wang","year":"2016","journal-title":"Ultrasound Med Biol"},{"issue":"3","key":"bib9-20231011","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1177\/0161734615589252","article-title":"Improved correlation of strain indices with cognitive dysfunction with inclusion of adventitial layer with carotid plaque","volume":"38","author":"Wang","year":"2016","journal-title":"Ultrason Imaging"},{"issue":"1","key":"bib10-20231011","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.ultrasmedbio.2013.08.001","article-title":"Correlation of cognitive function with ultrasound strain indices in carotid plaque","volume":"40","author":"Wang","year":"2014","journal-title":"Ultrasound Med Biol"},{"key":"bib11-20231011","first-page":"5627","article-title":"Estimation of ultrasound strain indices in carotid plaque and correlation to cognitive dysfunction","volume":"2014","author":"Wang","year":"2014","journal-title":"Conf Proc IEEE Eng Med Biol Soc"},{"issue":"8","key":"bib12-20231011","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1001\/jamaneurol.2016.1388","article-title":"Cerebral microbleeds, cognition, and therapeutic impli-cations","volume":"73","author":"Gorelick","year":"2016","journal-title":"JAMA Neurol"},{"issue":"8","key":"bib13-20231011","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1001\/jamaneurol.2016.1017","article-title":"Association of cerebral microbleeds with cognitive decline and dementia","volume":"73","author":"Akoudad","year":"2016","journal-title":"JAMA Neurol"},{"issue":"4","key":"bib14-20231011","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.biopsych.2006.12.010","article-title":"Asymptomatic spontaneous cerebral emboli predict cognitive and functional decline in dementia","volume":"62","author":"Purandare","year":"2007","journal-title":"Biol Psychiatry"},{"issue":"1-2","key":"bib15-20231011","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jns.2009.02.306","article-title":"Cerebral microemboli in the genesis of dementia","volume":"283","author":"Purandare","year":"2009","journal-title":"J\u00a0Neurol Sci"},{"issue":"5","key":"bib16-20231011","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1227\/01.NEU.0000210246.61817.FE","article-title":"Increased angiogenesis and angiogenic gene expression in carotid artery plaques from symptomatic stroke patients","volume":"58","author":"T\u00fcreyen","year":"2006","journal-title":"Neurosurgery"},{"issue":"5","key":"bib17-20231011","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.neuint.2013.07.014","article-title":"All's well that transcribes well: non-coding RNAs and post-stroke brain damage","volume":"63","author":"Vemuganti","year":"2013","journal-title":"Neurochem Int"},{"issue":"575","key":"bib18-20231011","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1192\/bjp.123.4.467","article-title":"The set test as an aid to the detection of dementia in old people","volume":"123","author":"Isaacs","year":"1973","journal-title":"Br J Psychiatry"},{"issue":"1","key":"bib20-20231011","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1080\/01688638608401298","article-title":"Retrieval from semantic memory in Alzheimer-type dementia","volume":"8","author":"Ober","year":"1986","journal-title":"J\u00a0Clin Exp Neuropsychol"},{"issue":"Pt 6","key":"bib22-20231011","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1093\/brain\/awg128","article-title":"California Verbal Learning Test: performance by patients with focal frontal and non-frontal lesions","volume":"126","author":"Alexander","year":"2003","journal-title":"Brain"},{"key":"bib23-20231011","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1080\/13854049508400484","article-title":"Empirical comparison of alternative forms of the Boston naming test","volume":"9","author":"Franzen","year":"1995","journal-title":"Clin Neuropsychol"},{"key":"bib24-20231011","first-page":"286","article-title":"L\u2019examen psychologique dans les cas d\u2019encephalopathie traumatique","volume":"28","author":"Rey","year":"1941","journal-title":"Arch de Psychologie"},{"key":"bib25-20231011","first-page":"206","article-title":"Le test de copie d\u2019une figure complexe","volume":"30","author":"Osterrieth","year":"1944","journal-title":"Arch de Psychologie"},{"issue":"4","key":"bib27-20231011","doi-asserted-by":"crossref","first-page":"3774","DOI":"10.1016\/j.neuroimage.2011.11.032","article-title":"An automated tool for detection of FLAIR-hyperintense whitematter lesions in multiple sclerosis","volume":"59","author":"Schmidt","year":"2012","journal-title":"Neuroimage"},{"issue":"6","key":"bib28-20231011","first-page":"1123","article-title":"Consensus committee of the ninth international cerebral hemodynamic symposium","volume":"26","year":"1995","journal-title":"Stroke"},{"issue":"9","key":"bib29-20231011","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1016\/j.neurobiolaging.2009.10.013","article-title":"White matter hyperintensities and cognition: testing the reserve hypothesis","volume":"32","author":"Brickman","year":"2011","journal-title":"Neurobiol Aging"},{"issue":"4","key":"bib30-20231011","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.neurobiolaging.2013.10.072","article-title":"Regional white matter hyperin-tensities: aging, Alzheimer's disease risk, and cognitive function","volume":"35","author":"Birdsill","year":"2014","journal-title":"Neurobiol Aging"},{"issue":"pt 1","key":"bib31-20231011","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1093\/brain\/awu313","article-title":"Temporal lobe surgery in childhood and neuroanatomical predictors of long-term declarative memory outcome","volume":"138","author":"Skirrow","year":"2015","journal-title":"Brain"},{"issue":"4","key":"bib32-20231011","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1111\/epi.13327","article-title":"Where are they now? Psychosocial, educational, and vocational outcomes after epilepsy surgery in childhood","volume":"57","author":"Puka","year":"2016","journal-title":"Epilepsia"}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/neurosurgery\/article-pdf\/82\/3\/322\/32600058\/nyx173.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/00006123-201803000-00018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:49:32Z","timestamp":1786121372000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00006123-201803000-00018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6,1]]},"references-count":29,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyx173","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,6,1]]}}}