Cognitive impairment and quality of life in patients with carotid artery stenosis pre-revascularization: a scoping review.

Abstract

Background: Carotid artery stenosis (CAS) reduces cerebral blood flow and is frequently associated with cognitive impairment and reduced quality of life (QoL), particularly in severe CAS. Although carotid revascularization (stenting or endarterectomy) can improve blood flow and potentially enhance cognitive function and QoL, the impact of CAS before revascularization remains unclear.

Objective: This review aimed to synthesize the literature exploring the relationship between CAS, cognitive impairment, and QoL, focusing on pre-revascularization outcomes.

Method: A comprehensive scoping review was conducted using PubMed, CINAHL, MEDLINE, EMBASE, PsycINFO, EBSCO, and Scopus to identify relevant studies published between 2015 and 2023.

Results: This review identified consistent evidence linking severe CAS (≥70%) to significant cognitive decline, particularly in areas such as memory, attention, and executive function. Although carotid revascularization showed promise in improving cognitive performance, the extent of recovery varied. Studies also highlighted the profound impact of CAS on QoL, with patients frequently experiencing anxiety, depression, and physical limitations. While revascularization procedures were associated with improvements in physical functioning and overall well-being, emotional recovery often delayed.

Conclusion: CAS substantially affects both cognitive functioning and QoL, even before revascularization. Although some studies suggested that revascularization may lead to improvements in cerebral perfusion and certain domains of cognitive function, the trajectory of psychosocial and emotional recovery; including depressive symptoms, anxiety, and fear of future cerebrovascular events, demonstrates delayed improvement. These emotional outcomes mediate overall QoL and should be a focus of both clinical assessment and future longitudinal studies. Standardization of cognitive and psychosocial outcome measures is essential.