Severe carotid stenosis and impaired cerebral hemodynamics can influence cognitive deterioration

Abstract

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.

Thresholds of impaired cerebral hemodynamics that predict short-term cognitive decline in asymptomatic carotid stenosis

“…In a previous investigation, we found that a 0.69 BHI value was able to predict at least a three-point loss in MMSE score during a three-year follow-up period. 10 The results of the present study show that the individuation of subjects at risk of a subtle cognitive decline in a shorter time-period may require the consideration of less severe degrees of cerebral hemodynamic impairment. Accordingly, the use of a cut-off BHI value of 0.69 in the present investigation would not have allowed the identification of five (4.2%) subjects at risk of cognitive impairment.…”

“…Among them, 257 subjects had already been enrolled in our previous study exploring the relationship between cerebrovascular impairment and the long-term risk of cognitive deterioration. 10 The mean age was 69.95 (AE4.81) years, with an M:F ratio of 0.51 (males 33.8%) and a mean education of 10.35 (AE3.63) years; 19.2% of the subjects were smokers and 4.6% abused alcoholic drinks. Diabetes was present in 17.5%, hypertension in 57.3%, and dyslipidemia in 24.5%; 2.7% of the sample was affected by AF, 6.4% by previous MI and 4.9% by PAD.…”

“…10,11 Previous investigations have demonstrated a significant link between reduced cerebrovascular reactivity (CVR) to hypercapnia and the risk of cognitive deterioration in subjects with carotid stenosis. 3,10,12 In the present study, we aimed to detect a specific threshold of impaired CVR that predicts in ACS the risk of cognitive deterioration. Based on the widely shared concept that any therapeutic intervention to contrast cognitive impairment requires an early diagnosis, we established to take into consideration even slight changes in cognitive perormance during a one-year period.…”

Cognitive Deterioration in Bilateral Asymptomatic Severe Carotid Stenosis

“…1 We recently reported that asymptomatic subjects with severe narrowing of internal carotid artery (ICA) lumen may present a reduction in cognitive performances attributable to the activity of the hemisphere ipsilateral to the stenosis, 2 and in some cases, it may develop a cognitive deterioration. 3 Such consequences are more common if cerebral hemodynamics in the territory supplied by the stenotic ICA is altered. 3 Furthermore, patients with bilateral carotid stenosis may present a reduction in specific cognitive domains depending on the more hemodynamically compromised brain hemisphere.…”

Second European Stroke Science Workshop

“…Decreased cerebral vascular reserve seems to be an independent marker for progression of cognitive decline. 35 Carotid revascularization in unselected patients does not seem to improve cognition. In patients with severe preoperative hypoperfusion, however, several uncontrolled studies have shown possible improvement of cognition, but a well-designed small RCT did not show any benefits.…”