Cognitive disorders in patients with occlusive disease of the carotid artery: a systematic review of the literature

Abstract

We present a systematic review of the literature on the prevalence, nature, severity, course, and causes of cognitive deficits in patients with occlusive disease of the carotid artery prior to surgery (if surgery was under discussion). Searches were carried out on Medline and Psychlit from 1980 to 1999 using neurovascular and psychological index terms, and papers and books were checked for further references. Studies describing neuropsychological assessment of groups of patients with carotid obstruction were included. Eighteen studies were found. We extracted from the papers data on study design, demographic characteristics of patients, clinical diagnosis, carotid obstruction, cerebral imaging, time interval between ischemic episode and neuropsychological assessment, neuropsychological assessment procedures, integration and interpretation of test performances, and conclusions of authors. Fourteen studies concluded that there are cognitive deficits both in patients with symptomatic and in those with asymptomatic carotid obstruction; four studies denied cognitive impairment. There were no differences in patient characteristics, study design, or neuropsychological assessment procedures between the 14 studies that found deficits and the 4 that did not. There are indications for a mild, diffuse detrimental effect of carotid occlusive disease on cognitive functioning. However, methodological problems prevent a definitive conclusion. Further research is needed to confirm these findings and to ascertain the neurovascular risk factors for and the natural course of cognitive impairment in patients with carotid occlusive disease.

Neurocognitive Improvement After Carotid Artery Stenting in Patients With Chronic Internal Carotid Artery Occlusion and Cerebral Ischemia

“…5 In patients without clinical or imaging evidence of ischemic events, high-grade carotid stenosis 21 or occlusion 6 can still lead to cognitive decline. These observations suggest that restoration of cerebral circulation may lead to cognitive improvement in certain patient subsets.…”

“…1, 2 The detrimental effect of cerebral infarction on cognitive function is well known, 3,4 and cognitive deficits in asymptomatic ICAO patients have also been documented. 5 In the latter, cerebral hypoperfusion may be an important cause. 6 -8 Treatment for carotid artery stenosis includes carotid artery stenting and carotid endarterectomy.…”

Cerebral Hemodynamics and Metabolism in Patients With Symptomatic Occlusion of the Internal Carotid Artery

“…21 Possibly, the reduction in the NAA concentration is related to impaired cognition, which can be found in patients with a symptomatic ICA occlusion. 22 Our patients showed no correlation between NAA concentration and cerebral perfusion. This implies that the NAA concentration does not represent the current perfusion status.…”

A 30-Year-Old Female with Moyamoya Disease and Associated Depression

“…15 One study conducted in Shanghai in 2013 involving 26 adult patients with hemorrhagic MMD concluded there is a strong connection between the disease and depression, as 19 of the 26 (73%) patients in the study developed depression. 16 A case report published in 2010 describing a 25-year-old female with a history of MMD and depressive disorder also supports a connection between the two diseases.…”