Cognitive impairment in patients with carotid artery occlusion and ipsilateral transient ischemic attacks
Cognitive impairment in patients with carotid artery occlusion and ipsilateral transient ischemic attacks
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DOI：
10.1007/s00415-003-0222-1
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发表时间：
2003-11-01
影响因子：
6
通讯作者：
Kappelle, LJ
中科院分区：
文献类型：
--
作者：
Bakker, FC;Klijn, CJM;Kappelle, LJ
虽然短暂性脑缺血发作(TIA)的定义不会导致持久的神经功能障碍，但有研究表明，患有TIA的颈动脉疾病患者存在认知障碍。本研究的目的是评估颈动脉疾病和TIA患者是否存在认知损害，描述这种损害的频率、性质和严重程度，并寻找相关的患者特征。39例颈动脉闭塞和同侧大脑或视网膜TIA患者和46名健康对照接受了广泛的神经心理学评估。组间比较采用方差分析。此外，还确定了个体患者是否存在认知障碍。通过回归分析探讨了疾病特征与认知功能障碍之间的关系。54%的患者存在认知功能障碍。认知缺陷本质上是非特异性的，严重程度较轻。在有孤立视网膜症状的患者和那些在MRI上没有可见的缺血性脑损伤的患者中也会出现损害。任何血管危险因素的存在、有症状的颈动脉闭塞一侧、颈动脉闭塞的单侧或双侧、以及脑缺血病变的数量都不是认知损害的预测因素。我们得出结论，大约一半的颈动脉闭塞和同侧TIA患者存在认知损害。在有孤立视网膜症状的患者和那些在MRI上没有脑缺血损害的患者中存在认知缺陷，这与结构性脑损伤在这些缺陷的发病机制中所起的唯一作用相抵触。
Although transient ischemic attacks (TIAs) by definition do not cause lasting neurological deficits, cognitive impairment has been suggested in patients with carotid artery disease who have suffered from a TIA. The purpose of our study was to assess whether patients with carotid artery disease and TIAs are cognitively impaired, to describe the frequency, nature and severity of this impairment, and to search for associated patient characteristics.Thirty-nine consecutive patients with carotid occlusion and ipsilateral cerebral or retinal TIAs, and 46 healthy controls underwent extensive neuropsychological assessment. Performances were compared group-wise with analysis of variance. In addition, the presence of cognitive impairment in the individual patient was determined. Associations between illness characteristics and cognitive impairment were explored with regression analysis.Fifty-four percent of patients were cognitively impaired. Cognitive deficits were non-specific in nature and mild in severity. Impairment occurred also in patients with isolated retinal symptoms and in those without visible ischemic brain lesions on MRI. Neither the presence of any vascular risk factor, the side of the symptomatic carotid occlusion, the uni- or bilaterality of carotid occlusion, nor the number of cerebral ischemic lesions were predictors of cognitive impairment.We conclude that about half of the patients with carotid artery occlusion and ipsilateral TIAs are cognitively impaired. The presence of cognitive deficits in patients with isolated retinal symptoms and in those without cerebral ischemic lesions on MRI argues against an exclusive role for structural brain damage in the pathogenesis of these deficits.