BACKGROUND: Whether carotid artery disease is a cause of cognitive impairment in persons who have not had stroke is unknown. If this is the case, diminished performance on the Modified Mini-Mental State Examination should be more common in persons with left carotid artery disease than in those with right carotid artery disease. OBJECTIVE: To determine whether left carotid artery disease is associated with cognitive impairment. DESIGN: Cross-sectional and cohort study. SETTING: Four U.S. communities participating in the Cardiovascular Health Study. PATIENTS: 4006 right-handed men and women 65 years of age or older without history of stroke, transient ischemic attack, or carotid endarterectomy. MEASUREMENTS: Internal carotid artery stenosis and intima-media thickness of the common carotid artery were assessed by using duplex ultrasonography. Cognitive impairment was defined as a score less than 80 on the Modified Mini-Mental State Examination, and cognitive decline was defined as an average decrease of more than 1 point annually in Modified Mini-Mental State Examination score during up to 5 years of follow-up. Multivariate logistic regression models were used to estimate the risk for cognitive impairment and decline associated with left internal carotid artery stenosis and intima-media thickness, after adjustment for measures of right-sided disease and risk factors for vascular disease. RESULTS: After adjustment for right-sided stenosis, high-grade (> or =75% narrowing of diameter) stenosis of the left internal carotid artery (32 patients) was associated with cognitive impairment (odds ratio, 6.7 [95% CI, 2.4 to 18.1] compared with no stenosis) and cognitive decline (odds ratio, 2.6 [CI, 1.1 to 6.3]). Intima-media thickness of the left common carotid artery was associated with cognitive impairment and decline in univariate analysis, but this effect did not persist after adjustment. CONCLUSIONS: Cognitive impairment and decline are associated with asymptomatic high-grade stenosis of the left internal carotid artery. The persistence of the association after adjustment for right-sided stenosis indicates that the association is not due to underlying vascular risk factors or atherosclerosis in general.
BACKGROUND: Whether carotid artery disease is a cause of cognitive impairment in persons who have not had stroke is unknown. If this is the case, diminished performance on the Modified Mini-Mental State Examination should be more common in persons with left carotid artery disease than in those with right carotid artery disease. OBJECTIVE: To determine whether left carotid artery disease is associated with cognitive impairment. DESIGN: Cross-sectional and cohort study. SETTING: Four U.S. communities participating in the Cardiovascular Health Study. PATIENTS: 4006 right-handed men and women 65 years of age or older without history of stroke, transient ischemic attack, or carotid endarterectomy. MEASUREMENTS: Internal carotid artery stenosis and intima-media thickness of the common carotid artery were assessed by using duplex ultrasonography. Cognitive impairment was defined as a score less than 80 on the Modified Mini-Mental State Examination, and cognitive decline was defined as an average decrease of more than 1 point annually in Modified Mini-Mental State Examination score during up to 5 years of follow-up. Multivariate logistic regression models were used to estimate the risk for cognitive impairment and decline associated with left internal carotid artery stenosis and intima-media thickness, after adjustment for measures of right-sided disease and risk factors for vascular disease. RESULTS: After adjustment for right-sided stenosis, high-grade (> or =75% narrowing of diameter) stenosis of the left internal carotid artery (32 patients) was associated with cognitive impairment (odds ratio, 6.7 [95% CI, 2.4 to 18.1] compared with no stenosis) and cognitive decline (odds ratio, 2.6 [CI, 1.1 to 6.3]). Intima-media thickness of the left common carotid artery was associated with cognitive impairment and decline in univariate analysis, but this effect did not persist after adjustment. CONCLUSIONS:Cognitive impairment and decline are associated with asymptomatic high-grade stenosis of the left internal carotid artery. The persistence of the association after adjustment for right-sided stenosis indicates that the association is not due to underlying vascular risk factors or atherosclerosis in general.
Authors: Gail A Laughlin; Linda K McEvoy; Denise von Mühlen; Lori B Daniels; Donna Kritz-Silverstein; Jaclyn Bergstrom; Kevin Cummins; Claudia Der-Martirosian; Simerjot K Jassal; Elizabeth Barrett-Connor Journal: Psychosom Med Date: 2011-09-23 Impact factor: 4.312
Authors: Wenjun Zhong; Karen J Cruickshanks; Guan-Hua Huang; Barbara E K Klein; Ronald Klein; F Javier Nieto; James S Pankow; Carla R Schubert Journal: Atherosclerosis Date: 2011-07-20 Impact factor: 5.162
Authors: L H Kuller; O L Lopez; W J Jagust; J T Becker; S T DeKosky; C Lyketsos; C Kawas; J C S Breitner; A Fitzpatrick; C Dulberg Journal: Neurology Date: 2005-05-10 Impact factor: 9.910
Authors: José R Romero; Alexa Beiser; Sudha Seshadri; Emelia J Benjamin; Joseph F Polak; Ramachandran S Vasan; Rhoda Au; Charles DeCarli; Philip A Wolf Journal: Stroke Date: 2009-03-05 Impact factor: 7.914
Authors: Parthasarathy D Thirumala; Rajiv P Reddy; Oscar L Lopez; Yue-Fang Chang; James T Becker; Lewis H Kuller Journal: Clin Neurol Neurosurg Date: 2020-04-06 Impact factor: 1.876
Authors: A S Turk; I Chaudry; V M Haughton; B P Hermann; H A Rowley; K Pulfer; B Aagaard-Kienitz; D B Niemann; P A Turski; R L Levine; C M Strother Journal: AJNR Am J Neuroradiol Date: 2007-11-07 Impact factor: 3.825