Impaired cognitive function in patients with atherosclerotic carotid stenosis and correlation with ultrasound strain measurements.
Impaired cognitive function in patients with atherosclerotic carotid stenosis and correlation with ultrasound strain measurements.
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DOI：
10.1016/j.jns.2012.05.020
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发表时间：
2012-11-15
影响因子：
4.4
通讯作者：
Dempsey, Robert J.
中科院分区：
文献类型：
--
作者：
Rocque, Brandon G.;Jackson, Daren;Varghese, Tomy;Hermann, Bruce;McCormick, Matthew;Kliewer, Mark;Mitchell, Carol;Dempsey, Robert J.
关键词：
据推测，每年发生多达 1100 万起“无声”中风。虽然这些患者没有典型的神经功能缺陷，但他们可能表现出认知能力下降。在这项研究中，我们检查了颈动脉狭窄患者的认知功能。此外，我们评估了脉动颈动脉斑块应变的无创测量，以确定其预测认知能力下降的能力。我们对 44 名颈动脉狭窄患者进行了可重复电池神经心理状态评估 (RBANS)。所有患者的狭窄均符合 NASCET 或 ACAS 动脉内膜切除术标准，并根据这些出版物的定义分为有症状或无症状。比较有症状和无症状患者的 5 个 RBANS 领域（即刻记忆、视觉空间能力、语言、注意力和延迟记忆）的年龄调整得分。然后将这 5 个领域中每个领域的平均得分与所有其他领域进行比较，无论症状状态如何。在该队列中，23 名患者通过跟踪超声射频数据中的位移来评估心动周期中的轴向应变和主应变，从而对颈动脉斑块应变进行了评估。对 30 名有症状的患者和 14 名无症状的患者进行了研究。无论症状如何，视觉空间评分均显着低于任何其他领域（所有配对比较 p<0.05）。没有其他领域的得分与其他领域的得分有显着差异。在语言领域，无症状患者的得分显着高于有症状患者（p < 0.05。对于所有其他领域，没有发现差异。无症状患者显示斑块张力和即时记忆之间存在关系（r = -.61，p = ns）。随着累积压力的增加，左颈动脉疾病与多个认知领域的较差表现相关。这在右颈动脉疾病中没有看到。有大颈动脉斑块（> 70％狭窄）的患者在语言方面表现出明显的困难。虽然语言缺陷可能是中风症状的非特异性标志，但视觉空间缺陷出现在典型症状之前，这表明颈动脉疾病可能比以前怀疑的更早、更微妙地出现症状。异常的脉动分布可能与认知有关。
It has been postulated that up to 11 million “silent” strokes occur annually. While these patients are without classic neurologic deficits, they may exhibit cognitive decline. In this study, we examine the cognitive function of patients with carotid stenosis. Additionally, we evaluate a noninvasive measure of strain in pulsating carotid artery plaques to determine its ability to predict cognitive decline. We administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to 44 patients with carotid stenosis. All patients had stenosis meeting NASCET or ACAS criteria for endarterectomy, and were classified as symptomatic or asymptomatic as defined by these publications. Age-adjusted scores for each of the 5 RBANS domains (immediate memory, visuospatial ability, language, attention, and delayed memory) were compared between symptomatic and asymptomatic patients. Mean score for each of the 5 domains was then compared to all other domains, regardless of symptom status. From this cohort, 23 patients underwent assessment of carotid plaque strain by tracking displacements in ultrasound radiofrequency data to estimate axial and principal strains over the cardiac cycle. Thirty symptomatic and 14 asymptomatic patients were studied. Visuospatial scores were significantly lower than any other domain regardless of symptoms (p<0.05 for all pairwise comparisons). No other domain score was significantly different from any other. In the language domain, asymptomatic patients scored significantly higher than symptomatic patients (p<0.05. For all other domains, no difference was found. Asymptomatic patients showed a relationship between plaque strain and immediate memory (r= −.61, p=ns). Left carotid disease was associated with poorer performance across multiple cognitive domains with increasing accumulated strain. This was not seen in right carotid disease. Patients with large carotid plaques (>70% stenosis) exhibit significant difficulties in mental status whether classically symptomatic or asymptomatic. While language deficits may be a non-specific marker for stroke symptoms, visuospatial deficits are seen before classic symptoms, suggesting that carotid disease may become symptomatic earlier and more subtly than previously suspected. Abnormal strain distribution with pulsation may be related to cognition.
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