Severe carotid stenosis and impaired cerebral hemodynamics can influence cognitive deterioration
Severe carotid stenosis and impaired cerebral hemodynamics can influence cognitive deterioration
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DOI：
10.1212/wnl.0b013e318295d71a
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发表时间：
2013-06-01
期刊：
影响因子：
9.9
通讯作者：
Silvestrini, Mauro
中科院分区：
文献类型：
--
作者：
Balestrini, Simona;Perozzi, Cecilia;Silvestrini, Mauro
目的：评估严重颈动脉狭窄和相关血流动力学损害是否会增加无症状患者认知功能恶化的风险。方法：对210例单侧无症状重度颈动脉狭窄患者和109例健康对照组进行为期36个月的前瞻性评估。在入选时，定义了人口统计学、血管风险概况和药物治疗。采用经颅多普勒屏气指数(BHI)评价脑血流动力学。在入院时和随访期结束时用简易智力状态检查(MMSE)评估认知状态。结果：与无狭窄组相比，颈动脉狭窄组认知功能下降的概率明显增加(优势比[OR]4.16[95%可信区间(CI)1.89~9.11]；p<；0.001)。与狭窄同侧的BHI受损与认知功能减退的发生率增加相关(OR14.66[95%可信区间7.51-28.59]；P<；0.001)。结论：我们的研究结果表明，在无症状受试者中，存在严重的颈动脉狭窄会影响长达36个月的认知恶化。相关的血流动力学损害显著增加了风险。评估颈动脉狭窄的功能后果可能提供从无症状的重度颈动脉狭窄患者中选择认知损害风险增加的组的机会。
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.