Cognitive and physical performance in patients with asymptomatic carotid artery disease

The purpose of this study was to determine if patients with asymptomatic carotid artery stenosis and occlusion demonstrate deficits in cognitive and physical performance. The relationship between cognitive measures and performance of instrumental activities of daily living was examined. Seventy-nine patients with asymptomatic carotid artery stenosis of moderate and severe degrees or occlusion were tested. Cognition was assessed via the repeatable battery for the assessment of neuropsychological status (RBANS) and the executive interview (EXIT). Physical performance was assessed via the physical performance test (PPT) and the Lawton instrumental activities of daily living (IADL). Deficits in the RBANS visuospatial/constructional, attention, language and delayed memory domains were found for patients with occlusion. Deficits in all RBANS domains were found for the moderate stenosis subgroup, and deficits in all domains except language were found in the severe subgroup. No deficit was found in executive function in any group. Additionally, deficits were related to sidedness of involvement with visuospatial/constructional deficits related to right sided disease, and deficits in all cognitive domains except language were found in left sided and bilateral disease. Decreased performance on the PPT was identified in all three subgroups with the lowest scores in the moderate stenosis subgroup and the highest scores in the severe stenosis subgroup. The Lawton IADL did not identify any decrease in performance. Deficits in cognitive and physical function were found in this observational study of patients with asymptomatic carotid artery stenosis and occlusion, indicating that asymptomatic patients may not be truly asymptomatic. These areas of function and the potential change in their status need to be considered when patients are being evaluated for interventions to manage their carotid artery disease.