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Reduced neuropsychological test performance in asymptomatic carotid stenosis

The Tromsø Study

From the Institutes of Community Medicine (Drs. Mathiesen and Bønaa), Psychology (Dr. Waterloo), and Clinical Medicine (Drs. Joakimsen and Jacobsen), University of Tromsø, and Departments of Neurology (Drs. Mathiesen, Waterloo, and Joakimsen) and Radiology (Dr. Jacobsen), University Hospital of North Norway, Tromsø, Department of Neuroradiology (Dr. Bakke), National Hospital, Oslo, and Department of Cardiology (Dr. Bønaa), St. Olav’s Hospital, Trondheim, Norway.

Address correspondence and reprint requests to Dr. E.B. Mathiesen, Institute of Community Medicine, University of Tromsø, N-9037 Tromsø, Norway; e-mail: Ellisiv.Mathiesen{at}ism.uit.no

Objective: To assess the relationship between asymptomatic carotid stenosis, neuropsychological test performance, and silent MRI lesions.

Methods: Performance on several neuropsychological tests was compared in 189 subjects with ultrasound-assessed carotid stenosis and 201 control subjects without carotid stenosis, recruited from a population health study. Subjects with a previous history of stroke were excluded. The test battery included tests of attention, psychomotor speed, memory, language, speed of information processing, motor functioning, intelligence, and depression. Sagittal T1-weighted and axial and coronal T2-weighted spin echo MRI was performed, and presence of MRI lesions (white matter hyperintensities, lacunar and cortical infarcts) was recorded.

Results: Subjects with carotid stenosis had significantly lower levels of performance in tests of attention, psychomotor speed, memory, and motor functioning, independent of MRI lesions. There were no significant differences in tests of speed of information processing, word association, or depression. Cortical infarcts and white matter hyperintensities were equally distributed among persons with and without carotid stenosis. Lacunar infarcts were more frequent in the stenosis group (p = 0.03).

Conclusions: Carotid stenosis was associated with poorer neuropsychological performance. This could not be explained by a higher proportion of silent MRI lesions in persons with asymptomatic carotid stenosis, making it less likely that the cognitive impairment was caused by silent emboli.

Received May 15, 2003. Accepted in final form November 13, 2003.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the March 9 issue to find the title link for this article.

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