Carotid occlusion: Impact of cerebral hemodynamic impairment on cognitive performances
Giovanna Viticchi1, Lorenzo Falsetti2, Laura Buratti1
1Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
Insights
Carotid artery occlusion (CO) impacts cognitive function, particularly in patients with reduced cerebrovascular reactivity (CVR). This study highlights CVR assessment as key for identifying at-risk individuals.
Area of Science:
- Neurology
- Vascular Medicine
- Cognitive Neuroscience
Background:
- Carotid artery occlusion (CO) is a condition affecting blood flow to the brain.
- The relationship between CO, hemodynamic changes, and cognitive performance requires further investigation.
Purpose of the Study:
- To explore the association between carotid artery occlusion (CO) and cognitive performance.
- To determine if the side of CO and its hemodynamic effects influence cognitive outcomes.
- To assess the utility of cerebrovascular reactivity (CVR) in predicting cognitive decline.
Main Methods:
- 61 asymptomatic patients with unilateral CO were enrolled over 12 months.
- Cerebrovascular reactivity (CVR) was assessed using the breath-holding index (BHI) via transcranial Doppler (TCD) ultrasonography.
- Neuropsychological tests evaluated cognitive function ipsilateral to the CO at baseline and after 2 years.
Main Results:
- Lower cognitive scores (CPM, Rey Complex Figure Copy) were observed in patients with reduced ipsilateral BHI.
- Reduced BHI values correlated with a significant cognitive decline in CPM and Verbal Fluency tests over 2 years.
- These cognitive deficits were noted in patients with both right and left CO.
Conclusions:
- Hemodynamic alterations associated with CO may contribute to cognitive function decline.
- CVR assessment using TCD is a valuable tool for identifying asymptomatic CO patients at risk of cognitive deterioration.
- Early identification of at-risk patients can facilitate timely interventions.
Objectives:
The aim of this study was to investigate whether the presence of carotid artery occlusion (CO) may be associated with different cognitive performances in relation to the side of the occlusion and its hemodynamic consequences.
Methods:
During a 12-month period, 61 asymptomatic patients, 32 with right and 29 with left CO, were enrolled. Each patient underwent an assessment of cerebrovascular reactivity (CVR) to hypercapnia with transcranial Doppler (TCD) ultrasonography using the breath-holding index (BHI). Neuropsychological assessment evaluating performances of the hemisphere ipsilateral to CO were administered at entry (T0 ) and then repeated after 2 years (T1 ).
Results:
Scores obtained at colored progressive matrices (CPM) and Rey Complex Figure Copy Test were significantly lower at T0 in patients with reduced BHI values ipsilateral to CO. Multivariate models showed that reduced BHI values were also associated to a significant decrease from T0 to T1 in scores obtained for CPM and Categorical Verbal Fluency tests, respectively, in patients with right (P = 0.002) or left CO (P = 0.004).
Conclusions:
These findings suggest that hemodynamic alterations could be involved in the reduction in cognitive function regulated by the hemisphere ipsilateral to CO. The assessment of CVR with TCD ultrasonography may be a reliable approach for the individuation of asymptomatic patients with CO at increased risk of cognitive deterioration.
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