Cognitive function and carotid stenosis: review of the literature

Dutra, Aurélio Pimenta

doi:10.1590/S1980-57642012DN06030003

ABSTRACT

Stroke is a known cause of cognitive impairment but the relationship between asymptomatic carotid artery stenosis and cognitive function is not clear. The main risk factors for vascular disease are also related to carotid stenosis and cognitive impairment. The association of high-grade stenosis of the internal carotid artery with cognitive impairment is related to silent embolization and hypoperfusion, but it may also be present without evidence of infarction on magnetic resonance imaging. Carotid stenosis treatment may lead to a decline in cognitive function due to complications related to the procedures (endarterectomy or stenting). On the other hand, reperfusion may improve cognitive impairment. The best treatment choice is unclear, considering possible deterioration of cognitive function related to carotid artery stenosis. There is insufficient evidence to consider cognitive impairment an important factor in determining the therapy for carotid stenosis.

Key words:
carotid stenosis; cognitive function; endarterectomy; stent; hypoperfusion

RESUMO

O acidente vascular cerebral é uma doença que pode levar ao declínio cognitivo, mas a relação entre a estenose carotídea e as funções cognitivas não são bem esclarecidas. Os fatores de risco para doenças vasculares estão também relacionados à estenose de carótida e ao declínio cognitivo. A associação da estenose grave de carótida interna com o declínio cognitivo está relacionada a embolia silenciosa e hipoperfusão, mas pode também estar presente sem a evidência de lesão isquêmica pela ressonância. O tratamento da estenose carotídea pode levar ao declínio cognitivo devido a complicações relacionadas aos procedimentos (endarterectomia ou stent). Por outro lado a reperfusão pode melhorar o declínio cognitivo. Não está claro qual a melhor decisão terapêutica considerando a possível deterioração cognitiva relacionada à estenose carotídea. Não existe evidência suficiente para considerar o declínio cognitivo um fator importante na decisão terapêutica para estenose de carótida.

Palavras-chave:
estenose de carótida; função cognitiva; endarterectomia; stent; hipoperfusão

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REFERENCES

De Rango P, Caso V, Leys D, Paciaroni M, Lenti M, Cao P. The role of carotid artery stenting and carotid endarterectomy in cognitive performance: a systematic review. Stroke 2008;39:3116-3127.
Sztriha LK, Nemeth D, Sefcsik T, Vecsei L. Carotid stenosis and the cognitive function. J Neurol Sci 2009;283:36-40.
Johnston SC, O'Meara ES, Manolio TA. Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease. Ann Int Med 2004;140:237-134.
Irena Martini-Popović, Arijana Lovrenčić-Huzjan, Vida Demarin. Advanced asymptomatic carotid disease and cognitive impairment: an understated link? Stroke Res Treat 2012; doi:10.1155/2012/981416.
» https://doi.org/10.1155/2012/981416
Tombaugh TN, McIntyre NJ. The Mini-Mental State Examination: a comprehensive review. J Am Geriatr Soc 1992;40:922-935.
Nasreddine ZS, Phillips NA, B´edirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53:695-699.
Iris Zavoreo, Vanja Bašić Kes, Sandra Morović, Vesna Šerić, Vida Demarin. Breath holding index in detection of early cognitive decline. J Neurol Sci 2010; 299:116-119.
Romero JR, Beiser A, Seshadri S. Carotid artery atherosclerosis, MRI indices of brain ischemia, aging, and cognitive impairment The Framingham Study. Stroke 2009;40:1590-1596.
Arntzen KA , Schirmer H, Johnsen SH, Wilsgaard T, Mathiesen EB. Carotid atherosclerosis predicts lower cognitive test results: a 7-year follow-up study of 4,371 stroke-free subjects - The Tromsø Study. Cerebrovasc Dis 2012;33:159-165.
Johnston SC, O'Meara ES, Manolio TA. Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease. Ann Intern Med 2004;140:237-247.
Purandare N, Burns A, Daly KJ, et al. Cerebral emboli as a potential cause of Alzheimer's disease and vascular dementia: case-control study. BMJ 2006;332:1119-24.
De Rango P, Caso V, Leys D. The role of carotid artery stenting and carotid endarterectomy in cognitive performance a systematic review. Stroke 2008;39:3116-3127.
Hirooka R, Ogasawara K, Sasaki M. Magnetic resonance imaging in patients with cerebral hyperperfusion and cognitive impairment after carotid endarterectomy. J Neurosurg 2008;108:1178-1183.
Mracek J, Holeckova I, Chytra I, Mork J, Stepanek D, Vesela P. The impact of general versus local anesthesia on early subclinical cognitive function following carotid endarterectomy evaluated using P3 event-related potentials. Acta Neurochir 2012;154:433-438.
Chida K, Ogasawara K, Suga Y. Postoperative cortical neural loss associated with cerebral hyperperfusion and cognitive impairment after carotid endarterectomy 123I-iomazenil SPECT Study. Stroke 2009; 40:448-453.
Mocco J, Wilson DA, Komotar RJ, et al. Predictors of neurocognitive decline after carotid endarterectomy. Neurosurgery 2006;58:844-850.
Heyer EJ, Wilson DA, Sahlein DH, et al. APOEepsilon4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy. Neurology 2005;65:1759-1763.
Mocco J, Wilson DA, Ducruet AF, Komotar RJ, Mack WJ, Zurica J, et al. Elevations in preoperative monocyte count predispose to acute neurocognitive decline after carotid endarterectomy for asymptomatic carotid artery stenosis. Stroke 2006;37:240-242.
Ghogawala Z, Amin-Hanjani S, Curran J. The effect of carotid endarterectomy on cerebral blood flow and cognitive function. J Stroke Cerebrovasc Dis 2012; May 1. [Epub ahead of print].
Jacobs LA, Ganji S, Shirley JG, Morrell RM, Brinkman SD. Cognitive improvement after extracranial reconstruction for the low flow-endangered brain. Surgery 1983;93:683-687.
Kishikawa K, Kamouchi M, Okada Y, Inoue T, Ibayashi S, Iida M. Effects of carotid endarterectomy on cerebral blood flow and neuropsychological test performance in patients with high-grade carotid stenosis. J Neurol Sci 2003;213:19-24.

Publication Dates

Publication in this collection
Jul-Sep 2012

History

Received
26 Mar 2012
Accepted
29 May 2012

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] De Rango P, Caso V, Leys D, Paciaroni M, Lenti M, Cao P. The role of carotid artery stenting and carotid endarterectomy in cognitive performance: a systematic review. Stroke 2008;39:3116-3127.

[2] Sztriha LK, Nemeth D, Sefcsik T, Vecsei L. Carotid stenosis and the cognitive function. J Neurol Sci 2009;283:36-40.

[3] Johnston SC, O'Meara ES, Manolio TA. Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease. Ann Int Med 2004;140:237-134.

[4] Irena Martini-Popović, Arijana Lovrenčić-Huzjan, Vida Demarin. Advanced asymptomatic carotid disease and cognitive impairment: an understated link? Stroke Res Treat 2012; doi:10.1155/2012/981416.
» https://doi.org/10.1155/2012/981416

[5] Tombaugh TN, McIntyre NJ. The Mini-Mental State Examination: a comprehensive review. J Am Geriatr Soc 1992;40:922-935.

[6] Nasreddine ZS, Phillips NA, B´edirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53:695-699.

[7] Iris Zavoreo, Vanja Bašić Kes, Sandra Morović, Vesna Šerić, Vida Demarin. Breath holding index in detection of early cognitive decline. J Neurol Sci 2010; 299:116-119.

[8] Romero JR, Beiser A, Seshadri S. Carotid artery atherosclerosis, MRI indices of brain ischemia, aging, and cognitive impairment The Framingham Study. Stroke 2009;40:1590-1596.

[9] Arntzen KA , Schirmer H, Johnsen SH, Wilsgaard T, Mathiesen EB. Carotid atherosclerosis predicts lower cognitive test results: a 7-year follow-up study of 4,371 stroke-free subjects - The Tromsø Study. Cerebrovasc Dis 2012;33:159-165.

[10] Johnston SC, O'Meara ES, Manolio TA. Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease. Ann Intern Med 2004;140:237-247.

[11] Purandare N, Burns A, Daly KJ, et al. Cerebral emboli as a potential cause of Alzheimer's disease and vascular dementia: case-control study. BMJ 2006;332:1119-24.

[12] De Rango P, Caso V, Leys D. The role of carotid artery stenting and carotid endarterectomy in cognitive performance a systematic review. Stroke 2008;39:3116-3127.

[13] Hirooka R, Ogasawara K, Sasaki M. Magnetic resonance imaging in patients with cerebral hyperperfusion and cognitive impairment after carotid endarterectomy. J Neurosurg 2008;108:1178-1183.

[14] Mracek J, Holeckova I, Chytra I, Mork J, Stepanek D, Vesela P. The impact of general versus local anesthesia on early subclinical cognitive function following carotid endarterectomy evaluated using P3 event-related potentials. Acta Neurochir 2012;154:433-438.

[15] Chida K, Ogasawara K, Suga Y. Postoperative cortical neural loss associated with cerebral hyperperfusion and cognitive impairment after carotid endarterectomy 123I-iomazenil SPECT Study. Stroke 2009; 40:448-453.

[16] Mocco J, Wilson DA, Komotar RJ, et al. Predictors of neurocognitive decline after carotid endarterectomy. Neurosurgery 2006;58:844-850.

[17] Heyer EJ, Wilson DA, Sahlein DH, et al. APOEepsilon4 predisposes to cognitive dysfunction following uncomplicated carotid endarterectomy. Neurology 2005;65:1759-1763.

[18] Mocco J, Wilson DA, Ducruet AF, Komotar RJ, Mack WJ, Zurica J, et al. Elevations in preoperative monocyte count predispose to acute neurocognitive decline after carotid endarterectomy for asymptomatic carotid artery stenosis. Stroke 2006;37:240-242.

[19] Ghogawala Z, Amin-Hanjani S, Curran J. The effect of carotid endarterectomy on cerebral blood flow and cognitive function. J Stroke Cerebrovasc Dis 2012; May 1. [Epub ahead of print].

[20] Jacobs LA, Ganji S, Shirley JG, Morrell RM, Brinkman SD. Cognitive improvement after extracranial reconstruction for the low flow-endangered brain. Surgery 1983;93:683-687.

[21] Kishikawa K, Kamouchi M, Okada Y, Inoue T, Ibayashi S, Iida M. Effects of carotid endarterectomy on cerebral blood flow and neuropsychological test performance in patients with high-grade carotid stenosis. J Neurol Sci 2003;213:19-24.

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