Asymptomatic carotid stenosis is associated with cognitive impairment

Lal, Brajesh K.; Dux, Moira C.; Sikdar, Siddhartha; Goldstein, Carly; Khan, Amir; Yokemick, John; Zhao, Limin

doi:10.1016/j.jvs.2017.04.038

Cited by 112 publications

(113 citation statements)

References 45 publications

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“…As illustrated in Figure 1, 9 of the patients whose MFV was < 45 cm/s had Z-scores ≥0, and 5 with MFV ≥45 cm/s had Z-scores < 0. In addition, the average degree of cognitive decline was relatively mild, which has been previously reported for this population [16]. Nonetheless, our findings have implications for the management of carotid artery disease.…”

Section: Discussion/conclusionsupporting

confidence: 80%

“…Most pertinent to the current study, an increasing body of evidence suggests that cerebral hemodynamic impairment in patients with high-grade carotid artery stenosis may independently contribute to cognitive dysfunction [11,12]. Among patients with "asymptomatic" carotid stenosis, this evidence carries the most weight because the confounding factors of stroke-related cognitive disturbance are not present [13][14][15][16]. It is conceivable, therefore, that if hemodynamic impairment due to the carotid stenosis is a factor in cognitive decline, then improved cerebral blood flow following carotid revascularization by surgery or stenting could lead to improvements in cognition.…”

Section: Introductionmentioning

confidence: 94%

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Cognitive Impairment Correlates Linearly with Mean Flow Velocity by Transcranial Doppler below a Definable Threshold

Marshall

Pavol

Cheung

et al. 2020

Cerebrovasc Dis Extra

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Introduction: Low cerebral blood flow can affect cognition in patients with high-grade asymptomatic internal carotid artery stenosis. Current clinical algorithms use stroke risk to determine which patients should undergo revascularization without considering cognitive decline. Although correlations between low-flow and cognitive impairment have been reported, it is not known whether a threshold exists below which such a correlation expresses itself. Such information would be critical in treatment decisions about whether to intervene in patients with high-grade carotid artery stenosis who are at risk for cognitive decline. Objective: To determine how reduced blood flow correlates with lower cognitive scores. Methods: Patients with ≥80% unilateral internal carotid artery stenosis with no history of stroke were recruited from inpatient and outpatient practices at a single, large, comprehensive stroke center. Patients underwent bilateral insonation of middle cerebral arteries with standard 2-Hz probes over the temporal windows with transcranial Doppler. Cognitive assessments were performed by an experienced neuropsychologist using a cognitive battery comprising 14 standardized tests with normative samples grouped by age. Z-scores were generated for each test and averaged to obtain a composite Z-score for each patient. Multivariable linear regression examined associations between mean flow velocity (MFV) and composite Z-score, adjusting for age, education, and depression. The Davies test was used to determine if there was a breakpoint for a non-zero difference in slope of a segmented relationship over the range of composite Z-score values. Results: Forty-two patients with unilateral high-grade internal carotid artery stenosis without stroke were enrolled (26 males, age = 74 ± 9 years, education = 16 ± 3 years). Average composite Z-score was -0.31 SD below the age-specific normative mean (range -2.8 to +1.2 SD). In linear regression adjusted for age, education, and depression, MFV correlated with cognitive Z-score (β = 0.308, p = 0.043). A single breakpoint in the range of composite Z-scores was identified at 45 cm/s. For MFV < 45 cm/s, Z-score decreased 0.05 SD per cm/s MFV (95% CI: 0.01-0.10). For MFV > 45 cm/s, Z-score change was nonsignificant (95% CI: -0.07 to 0.05). Conclusions: In high-grade, asymptomatic carotid artery stenosis, cognitive impairment correlated linearly with lower flow in the hemisphere fed by the occluded internal carotid artery, but only below a threshold of MFV = 45 cm/s. Identifying a hemodynamic threshold for cognitive decline using a simple, noninvasive method may influence revascularization decision-making in otherwise "asymptomatic" carotid disease.

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Section: Discussion/conclusionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 94%

Cognitive Impairment Correlates Linearly with Mean Flow Velocity by Transcranial Doppler below a Definable Threshold

Marshall

Pavol

Cheung

et al. 2020

Cerebrovasc Dis Extra

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“…KAD'nın derecesi arttıkça inme riskinin de arttığı bilinmektedir (3). Geçici iskemik atak ile başvuran hastaların ise %8-13'ünde KAD mevcuttur (4 (8,9). Primer asemptomatik KAD olan hastaların %6'sında geçici islemik atak gibi minör iskemik olaylar görülmektedir.…”

Section: Epidemiyolojiunclassified

“…KAD ateroembolik inmenin iyi bilinen nedenleri arasındadır. Kognitif yetmezlik ise diabet, hipertansiyon, hiperlipidemi gibi vasküler risk faktörleriyle veya inmeyle birlikte görülebilir (9). İnme sonrası beyin hasarına bağlı gelişen, bilişsel fonksiyonlarda kayıpla giden klinik tabloya vasküler demans (VaD) denir.…”

Section: Karotis Arter Darlığı Ve Kognitif Bozukluklarunclassified

The effect of asymptomatic carotid artery stenosis on cognitive functions

Çelik¹,

Aykaç²

2019

TÃ¼rk Beyin Damar Hast Derg

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Hem serebrovasküler hastalıklar hem demans günlük yaşamı ve zihinsel yetileri bozan önemli klikin durumlardır. Karotis arter darlığı iskemik inmelerin %10-15'inin nedenidir. Hem hafif kognitif bozukluk hem de Alzheimer Hastalığını da dahil olmak üzere tüm demans nedenlerinin etyolojisinde semptomatik ve asemptomatik karotis arter darlığı az bilinen ama önemli bir risk faktörüdür. Bu derlemede asemptomatik karotis darlığının kognisyona olan etkisinin tartışılması amaçlanmaktadır. ABSTRACTBoth cerebrovascular diseases and dementia are important clinical conditions that disrupt daily life and mental abilities. Carotid artery stenosis is the cause of 10-15% of ischemic strokes. Symptomatic and asymptomatic carotid artery stenosis is a little-known, but important risk factor in the etiology of all causes of dementia, including both mild cognitive impairment and Alzheimer's disease. In this review, the effect of asymptomatic carotid artery stenosis on cognition is discussed.

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“…Silent strokes, that may not cause frank symptoms, could result in vascular cognitive impairment (VCI) due to migration of micro‐emboli from vulnerable carotid plaques to sensitive brain vasculature. VCI can be assessed using cognitive testing and has been observed in asymptomatic patients, pointing to a possible role of micro‐emboli causing cognitive deficits …”

Section: Introductionmentioning

confidence: 99%

Lagrangian carotid strain imaging indices normalized to blood pressure for vulnerable plaque

Varghese

Meshram

Mitchell

et al. 2019

J of Clinical Ultrasound

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Objective Ultrasound Lagrangian carotid strain imaging (LCSI) utilizes physiological deformation caused by arterial pressure variations to generate strain tensor maps of the vessel walls and plaques. LCSI has been criticized for the lack of normalization of magnitude‐based strain indices to physiological stimuli, namely blood pressure. We evaluated the impact of normalization of magnitude‐based strain indices to blood pressure measured immediately after the acquisition of radiofrequency (RF) data loops for LCSI. Materials and Methods A complete clinical ultrasound examination along with RF data loops for LCSI was performed on 50 patients (30 males and 20 females) who presented with >60% carotid stenosis and were scheduled for carotid endarterectomy. Cognition was assessed using the 60‐minute neuropsychological test protocol. Results For axial strains correlation of maximum accumulated strain indices (MASI), cognition scores were −0.46 for non‐normalized and −0.45, −0.49, −0.37, and −0.48 for systolic, diastolic, pulse pressure, and mean arterial pressure normalized data, respectively. The corresponding area under the curve (AUC) values for classifiers designed using maximum likelihood estimation of a binormal distribution with a median‐split of the executive function cognition scores were 0.73, 0.70, 0.71, 0.70, and 0.71, respectively. Conclusions No significant differences in the AUC estimates were obtained between normalized and non‐normalized magnitude‐based strain indices.

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Asymptomatic carotid stenosis is associated with cognitive impairment

Cited by 112 publications

References 45 publications

Cognitive Impairment Correlates Linearly with Mean Flow Velocity by Transcranial Doppler below a Definable Threshold

Cognitive Impairment Correlates Linearly with Mean Flow Velocity by Transcranial Doppler below a Definable Threshold

The effect of asymptomatic carotid artery stenosis on cognitive functions

Lagrangian carotid strain imaging indices normalized to blood pressure for vulnerable plaque

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