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Published on: April 23, 2021
Lower haemoglobin concentrations are associated with impaired cognition in patients with carotid artery occlusion
Sanne Kuipers1, Sean W Willemse1, Jacoba P Greving2
1Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands.
Insights
Lower hemoglobin levels are linked to cognitive impairment in patients with carotid artery occlusion. This association, particularly affecting attention and psychomotor speed, was not influenced by cerebral blood flow.
Area of Science:
- Neurology
- Hematology
- Cognitive Science
Background:
- Patients with carotid artery occlusion (CAO) face a heightened risk of cognitive impairment (CI).
- Anemia, a condition of lower hemoglobin, is a known risk factor for CI in the general population.
- The study investigates the relationship between hemoglobin levels and CI in CAO patients, considering cerebral blood flow (CBF).
Purpose of the Study:
- To determine if lower hemoglobin is associated with cognitive impairment in patients with carotid artery occlusion.
- To examine if cerebral blood flow accentuates the link between hemoglobin and cognitive impairment.
- To identify specific cognitive domains affected by lower hemoglobin in CAO patients.
Main Methods:
- 104 patients with complete carotid artery occlusion were analyzed.
- Anemia was defined by hemoglobin levels below 12 g/dL (women) or 13 g/dL (men).
- Cognitive function was assessed using standardized z-scores across four domains; regression models adjusted for age, sex, education, and stroke history; cerebral blood flow was measured using MRI.
Main Results:
- Anemia was present in 6% of patients and associated with a 2.54-fold increased risk of CI.
- Lower hemoglobin levels correlated with an increased risk of CI (RR 1.15 per g/dL decrease).
- The strongest association was observed in the attention-psychomotor speed domain (RR 1.27 per g/dL decrease).
Conclusions:
- Reduced hemoglobin concentrations are significantly associated with cognitive impairment in patients with carotid artery occlusion.
- The attention-psychomotor speed domain is particularly vulnerable to the effects of lower hemoglobin.
- Cerebral blood flow did not modify the association between hemoglobin and cognitive impairment, suggesting hemoglobin as a potential therapeutic target.
Background:
Patients with carotid artery occlusion (CAO) are vulnerable to cognitive impairment (CI). Anaemia is associated with CI in the general population. We hypothesized that lower haemoglobin is associated with cognitive impairment (CI) in patients with CAO and that this association is accentuated by cerebral blood flow (CBF).
Methods:
104 patients (mean age 66±8 years, 77% men) with complete CAO from the Heart-Brain Connection study were included. Anaemia was defined as haemoglobin < 12 g/dL for women and < 13 g/dL for men. Cognitive test results were standardized into z-scores (using a reference group) in four cognitive domains. Patients were classified as cognitively impaired when ≥ one domain was impaired. The association between lower haemoglobin and both cognitive domain z-scores and the presence of CI was assessed with adjusted (age, sex, education and ischaemic stroke) regression models. Total CBF (measured with phase contrast MRI) and the interaction term haemoglobin*CBF were additionally added to the analyses.
Results:
Anaemia was present in 6 (6%) patients and was associated with CI (RR 2.54, 95% CI 1.36; 4.76). Lower haemoglobin was associated with the presence of CI (RR per minus 1 g/dL haemoglobin 1.15, 95% CI 1.02; 1.30). This association was strongest for the attention-psychomotor speed domain (RR for impaired attention-psychomotor speed functioning per minus 1 g/dL haemoglobin 1.27, 95% CI 1.09;1.47) and ß for attention-psychomotor speed z-scores per minus 1 g/dL haemoglobin -0.19, 95% CI -0.33; -0.05). Adjustment for CBF did not affect these results and we found no interaction between haemoglobin and CBF in relation to cognition.
Conclusion:
Lower haemoglobin concentrations are associated with CI in patients with complete CAO, particularly in the domain attention-psychomotor speed. CBF did not accentuate this association. If validated in longitudinal studies, haemoglobin might be a viable target to prevent cognitive deterioration in patients with CAO.
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