Severe carotid stenosis and impaired cerebral hemodynamics can influence cognitive deterioration
Abstract
Objective:
To evaluate whether severe carotid stenosis and related hemodynamics impairment may increase the risk of cognitive deterioration in asymptomatic subjects.
Methods:
A total of 210 subjects with unilateral asymptomatic severe carotid stenosis and 109 healthy controls were included and prospectively evaluated for a 36-month period. At entry, demographics, vascular risk profile, and pharmacologic treatments were defined. Cerebral hemodynamics was assessed by transcranial Doppler–based breath-holding index (BHI) test. Cognitive status was evaluated with the Mini-Mental State Examination (MMSE) at entry and at the end of the follow-up period. Cognitive deterioration was defined as a decrease in the MMSE score of 3 points or more during the overall follow-up period.
Results:
Subjects with carotid stenosis showed an increased probability of developing cognitive deterioration compared with the group without stenosis (odds ratio [OR] 4.16 [95% confidence interval (CI) 1.89–9.11]; p < 0.001). The presence of an impaired BHI ipsilateral to the stenosis was associated with an increased incidence of reduction in cognitive performance (OR 14.66 [95% CI 7.51–28.59]; p < 0.001).
Conclusions:
Our findings show that the presence of a severe carotid stenosis influences cognitive deterioration over a 36-month period in asymptomatic subjects. An associated hemodynamic impairment significantly increases the risk. Evaluation of functional consequences of carotid stenosis may offer the opportunity to select a group with an increased risk of developing cognitive impairment from subjects with asymptomatic severe carotid stenosis.
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Information & Authors
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© 2013 American Academy of Neurology.
Publication History
Received: October 29, 2012
Accepted: February 19, 2013
Published online: April 26, 2013
Published in print: June 4, 2013
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
Study Funding
No targeted funding reported.
Authors
Author Contributions
Study concept and design: Drs. M. Silvestrini, C. Altamura, and S. Balestrini. Acquisition of data: Drs. C. Perozzi, C. Altamura, and M. Bartolini. Analysis and interpretation of data: Drs. S. Luzzi and L. Provinciali. Statistical analysis: Dr. S. Balestrini. Drafting of the manuscript: Drs. M. Silvestrini, S. Balestrini, and C. Perozzi. Critical revision of the manuscript for important intellectual content: Dr. L. Provinciali. Study supervision: Drs. M. Silvestrini and F. Vernieri.
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