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Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease.
Tuesday,2012-11-06 12:06 America/Los_Angeles — eenright
| Title | Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease. |
| Publication Type | Journal Article |
| Year of Publication | 2004 |
| Authors | S Johnston, C, O'Meara, ES, Manolio, TA, Lefkowitz, D, O'Leary, DH, Goldstein, S, Carlson, MC, Fried, LP, Longstreth, WT |
| Journal | Ann Intern Med |
| Volume | 140 |
| Issue | 4 |
| Pagination | 237-47 |
| Date Published | 2004 Feb 17 |
| ISSN | 1539-3704 |
| Keywords | Aged, Carotid Stenosis, Cognition Disorders, Cohort Studies, Cross-Sectional Studies, Female, Humans, Male, Neuropsychological Tests, Odds Ratio, Risk Factors, Tunica Intima |
| Abstract | <p><b>BACKGROUND: </b>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.</p><p><b>OBJECTIVE: </b>To determine whether left carotid artery disease is associated with cognitive impairment.</p><p><b>DESIGN: </b>Cross-sectional and cohort study.</p><p><b>SETTING: </b>Four U.S. communities participating in the Cardiovascular Health Study.</p><p><b>PATIENTS: </b>4006 right-handed men and women 65 years of age or older without history of stroke, transient ischemic attack, or carotid endarterectomy.</p><p><b>MEASUREMENTS: </b>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.</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>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.</p> |
| DOI | 10.7326/0003-4819-140-4-200402170-00005 |
| Alternate Journal | Ann Intern Med |
| PubMed ID | 14970146 |
| Grant List | N01-HC-15103 / HC / NHLBI NIH HHS / United States N01-HC-35129 / HC / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States N01-HC-85080 / HC / NHLBI NIH HHS / United States N01-HC-85081 / HC / NHLBI NIH HHS / United States N01-HC-85082 / HC / NHLBI NIH HHS / United States N01-HC-85083 / HC / NHLBI NIH HHS / United States N01-HC-85084 / HC / NHLBI NIH HHS / United States N01-HC-85085 / HC / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States NS02254 / NS / NINDS NIH HHS / United States |