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Genetic Polymorphisms Influence Cognition in Patients Undergoing Carotid Interventions
Elizabeth Hitchner, MA1, Doug Morrison1, Phoebe Liao1, Allyson Rosen, PhD2, Salil Soman, MD, MS3, Wei Zhou, MD3.
1Palo Alto Veterans Hospital, Palo Alto, CA, USA, 2Stanford University, Palo Alto, CA, USA, 3Stanford/Palo Alto Veterans Hospital, Palo Alto, CA, USA.

OBJECTIVES: Carotid interventions help decrease the risk of stroke and improve cerebral perfusion. However, nearly 40% of patients who undergo carotid revascularization procedures experience cognitive deterioration. We have demonstrated that subclinical microembolization is associated with memory decline. The role of genetic factors in cognitive function is unclear. We therefore sought to assess genetic determinants as potential risk factors for these procedures.
METHODS: Over two years patients undergoing carotid interventions at a single academic institution were recruited to participate. Patients underwent neuropsychological testing within two weeks prior to and at one month following their procedure and MRI prior to and at 24 hours following their procedure. Saliva samples were collected for genetic testing and demographics were recorded. Logistic regressions were used to search for associations.
RESULTS: 74 patients were included (43 CAS, 31 CEA); all were male with an average age of 70. The majority of patients exhibit hypertension (95%) and have a history of smoking (80%). Other co-morbidities included diabetes (47%), obesity (41%), and CAD (53%). CAS was associated with higher incidence of microemboli (p=<.001) and with susceptibility to memory decline (p=.007). Presence of ApoE 4 allele was associated with depression (p=.03) and demonstrated a trend with incidence of microemboli. A significant negative association was found between age and depression (p=.99). After correcting for age and BDNF polymorphism, prior symptoms were associated with depression (p=.02). Corrections for age and 5-HTT polymorphism also revealed a correlation between prior symptoms and depression (p=.03).
CONCLUSIONS: Our study demonstrates that genetic polymorphisms such as 5-HTT, BDNF, and ApoE may provide additional insight on depression in patients with carotid stenosis. Further investigation of these polymorphisms in relation to overall cognition is warranted to understand and potentially prevent cognitive changes following carotid revascularization procedures.

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