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Cognition often deteriorates when the brain's main blood vessels are clogged, but a Columbia-led study published in JAMA shows that cognition cannot be improved by opening the blockages with stenting or surgery.

"We had hoped that improving blood flow in the brain in this way would improve cognition—and there were tantalizing clues from animal studies and case series that it would," says study leader Randolph Marshall, M.D., the Elisabeth K. Harris Professor of Neurology at Columbia University Vagelos College of Physicians and Surgeons.

"But when we put it to the test in a randomized clinical trial, comparing cognition after opening the blockage or treatment with medication alone, we did not see a difference."

The study, called CREST-H, was a part of a larger trial to determine the best way to prevent strokes in people with severe carotid artery blockages. That multicenter study, called CREST-2, which Marshall helped design, found that medication combined with stenting, but not blockage-removing surgery, decreased strokes twofold compared to medication alone.

"Those results do appear to have changed practice already, and more of these patients are getting stents," says Marshall.

Severe carotid blockages are also associated with cognitive impairment even without stroke, particularly when cerebral blood flow is reduced.

"We've thought for a long time that restoring blood flow with stenting or surgery could improve cognition, but until our study, the hypothesis had never been tested in a randomized clinical trial."

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