Advanced Asymptomatic Carotid Disease and Cognitive Impairment: An Understated Link?

Abstract

Advanced carotid disease is known to be associated with symptomatic cerebrovascular diseases, such as stroke or transient ischemic attack (TIA), as well as with poststroke cognitive impairment. However, cognitive decline often occurs in patients with advanced carotid stenosis without clinically evident stroke or TIA, so it is also suspected to be an independent risk factor for dementia. Neurosonological methods enable simple and noninvasive assessment of carotid stenosis in patients at risk of advanced atherosclerosis. Cognitive status in patients diagnosed with advanced carotid stenosis is routinely not taken into consideration, although if cognitive impairment is present, such patients should probably be called symptomatic. In this paper, we discuss results of some most important studies that investigated cognitive status of patients with asymptomatic advanced carotid disease and possible mechanisms involved in the causal relationship between asymptomatic advanced carotid disease and cognitive decline.

Carotid disease at age 73 and cognitive change from age 70 to 76 years: A longitudinal cohort study

“… 9 Review articles are inconclusive on whether carotid stenosis leads to cognitive decline. 9 , 35 For example, declining cognitive function was associated with carotid plaque area but not luminal narrowing, 10 or carotid volume flow. 36 Removal of tight stenosis by carotid endarterectomy did not affect cognitive decline five years later.…”

Cognitive function and carotid stenosis: review of the literature

“…Patients with severe carotid disease without previous stroke or TIA can have subtle cognitive abnormalities that are undetectable by the MMSE and may only be identified by applying specific neuropsychological tests. 4 …”

“…If asymptomatic advanced carotid stenosis indeed causes cognitive impairment, the decision on surgical treatment might consider cognitive evaluation using a neuropsychological test as a clinical definition of symptomatic carotid disease and may be considered as important as the effective treatment of vascular risk factors in stroke/TIA free patients with carotid stenosis. 4 …”

The preventive effects of edible folic acid on cardiomyocyte apoptosis and survival in early onset triple‐transgenic Alzheimer's disease model mice

“…Cardiovascular disease and AD also share the same risk factors . Carotid artery and cardiovascular disease are the two major risk factors for AD . Some reports have indicated that patients with early onset AD had little cardiovascular damage, while patients with late‐onset AD exhibited evidence of ischemic damage to the left ventricular myocardium, and frequent heart valve damage …”