Impaired Cerebral Hemodynamics and Cognitive Performance in Patients with Atherothrombotic Disease

Area of Science:

• Neurology
• Cardiovascular Science
• Cognitive Neuroscience

Background:

• Patients with atherothrombotic disease often experience cognitive impairment.
• Cerebrovascular reactivity (CVR) is a key indicator of cerebral microvascular hemodynamic function.
• Impaired CVR may contribute to cognitive decline in at-risk populations.

Purpose of the Study:

• To investigate the association between impaired CVR and cognitive performance.
• To determine if this association differs in patients with and without carotid large-vessel disease.
• To explore the impact of cerebral microvascular dysfunction on cognitive domains.

Main Methods:

• A subgroup of 415 non-demented patients with chronic coronary heart disease were assessed.
• Cognitive function was evaluated using the Neurotrax Computerized Cognitive Battery.
• Cerebrovascular reactivity (CVR) was measured using the breath-holding index (BHI) via transcranial Doppler.
• Carotid plaques were identified using ultrasound.

Main Results:

• Impaired CVR (BHI <0.47) was associated with lower executive function and global cognitive scores, even after adjusting for confounders.
• A significant interaction was observed between impaired CVR and carotid large-vessel disease for executive function, memory, and global cognitive scores.
• In patients with carotid large-vessel disease, impaired CVR markedly reduced performance in executive function, memory, attention, and global cognition.

Conclusions:

• Impaired CVR, a marker of cerebral microvascular dysfunction, is significantly associated with poorer cognitive function.
• Executive dysfunction is particularly pronounced in non-demented patients with concomitant carotid large-vessel disease and impaired CVR.
• Cerebral hemodynamics play a crucial role in maintaining cognitive performance, especially in patients with cerebrovascular disease.