03477nas a2200385 4500008004100000022001400041245014400055210006900199260001600268300001100284490000800295520234400303653000902647653002102656653002402677653001902701653002802720653001102748653001102759653000902770653002902779653001502808653001702823653001802840100002402858700002202882700002102904700002102925700002302946700002202969700002502991700002003016700002003036856003503056 2004 eng d a1539-370400aCognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease.0 aCognitive impairment and decline are associated with carotid art c2004 Feb 17 a237-470 v1403 a

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.

10aAged10aCarotid Stenosis10aCognition Disorders10aCohort Studies10aCross-Sectional Studies10aFemale10aHumans10aMale10aNeuropsychological Tests10aOdds Ratio10aRisk Factors10aTunica Intima1 aJohnston, Claiborne1 aO'Meara, Ellen, S1 aManolio, Teri, A1 aLefkowitz, David1 aO'Leary, Daniel, H1 aGoldstein, Steven1 aCarlson, Michelle, C1 aFried, Linda, P1 aLongstreth, W T uhttps://chs-nhlbi.org/node/766