Is carotid artery atherosclerosis associated with poor cognitive function assessed using the Mini-Mental State Examination? A systematic review and meta-analysis

Abstract

ObjectivesTo determine associations between carotid atherosclerosis assessed by ultrasound and the Mini-Mental State Examination (MMSE), a measure of global cognitive function.DesignSystematic review and meta-analysis.MethodsMEDLINE and EMBASE databases were searched up to 1 May 2020 to identify studies assessed the associations between asymptomatic carotid atherosclerosis and the MMSE. Studies reporting OR for associations between carotid plaque or intima-media thickness (cIMT) and dichotomised MMSE were meta-analysed. Publication bias of included studies was assessed.ResultsA total of 31 of 378 reviewed articles met the inclusion criteria; together they included 27 738 participants (age 35–95 years). Fifteen studies reported some evidence of a positive association between measures of atherosclerosis and poorer cognitive performance in either cross-sectional or longitudinal studies. The remaining 16 studies found no evidence of an association. Seven cross-sectional studies provided data suitable for meta-analysis. Meta-analysis of three studies that assessed carotid plaque (n=3549) showed an association between the presence of plaque and impaired MMSE with pooled estimate for the OR (95% CI) being 2.72 (0.85 to 4.59). An association between cIMT and impaired MMSE was reported in six studies (n=4443) with a pooled estimate for the OR (95% CI) being 1.13 (1.04 to 1.22). Heterogeneity across studies was moderate to small (carotid plaque with MMSE, I2=40.9%; cIMT with MMSE, I2=4.9%). There was evidence of publication bias for carotid plaque studies (p=0.02), but not cIMT studies (p=0.2).ConclusionsThere is some, limited cross-sectional evidence indicating an association between cIMT and poorer global cognitive function assessed with MMSE. Estimates of the association between plaques and poor cognition are too imprecise to draw firm conclusions and evidence from studies of longitudinal associations between carotid atherosclerosis and MMSE is limited.PROSPERO registration numberCRD42021240077.

Associations of carotid atherosclerosis with cognitive function and brain health: Findings from a UK tri-ethnic cohort study (Southall and Brent Revisited)

“…Two recent systematic reviews have examined the relationship between carotid atherosclerosis and cognition. Baradaran et al [ 3 ] found evidence of an association between carotid artery plaque and poorer cognition based on clinical diagnosis or cognitive testing, while we [ 4 ] found some limited evidence for an adverse association between carotid atherosclerosis and a quantitative measure of cognitive performance, the Mini-Mental State Examination (MMSE). Neither review was able to account fully for confounding due to the disparate nature of the studies included.…”

B-mode ultrasound characteristics of carotid plaques in symptomatic and asymptomatic patients with low-grade stenosis

“…Carotid atherosclerotic plaque progression is associated with an increased risk of stroke and is responsible for 15–20% of ischemic strokes [ 8 – 10 ]. These plaques are also associated with poor cognitive function [ 11 ].…”

Association between Extracranial Carotid Artery Plaque and Cognitive Dysfunction: A Systematic Review and Meta-Analysis

“…Despite this difficulty, there are several longitudinal and cross-sectional studies, which have eval-uated this association. The existing studies which have assessed this link between carotid plaque and cognition have demonstrated mixed evidence without a definite consensus, including a recent small meta-analysis finding an association with CIMT, carotid plaque, and minimental status examination [14]. Currently, carotid plaque is primarily considered a major contributor to the development of ischemic stroke rather than a recognized risk factor for cognitive impairment.…”