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Cognitive Impairment in Patients with Significant Carotid Artery Disease

Friday, May 3, 2024

    Presenting Author(s)

  • Karlo A. Wiley

    Medical Student
    Tulane University School of Medicine
    New Orleans, LA, US

    • Co-Author(s)

  • AA

    Allison Anker, n/a

    Medical Student
    Tulane University School of Medicine, United States

  • GK

    Guliz Kozdag-Gold, MD

    Faculty
    Montefiore Einstein Center for Heart and Vascular Care - Albert Einstein College of Medicine, United States

  • cS

    cristina Sanina, MD

    Fellow
    Beth Israel Deaconess Medical Center - Harvard Medical School, United States

Introduction: Carotid artery stenosis plays an important role in cerebral ischemic event incidence, e.g., ischemic stroke or transient ischemic accident (TIA), accounting for about 14% of all ischemic strokes according to the Oxford Vascular Study. Notably, cognitive impairment often follows cerebral ischemic events. The aim of this study is to determine the prevalence and risk factors for cognitive impairment in patients with or without previous history of stroke and TIA diagnosed with severe carotid artery stenosis.

Methods: A total of 80 patients underwent cognitive evaluations before carotid artery revascularization including 46 men and 34 women, mean age 71±9 years. Cognitive impairment was defined as MMSE score less than 28. 30 patients (37.5%) had cognitive impairment. 28 patients (35%) had previous history of stroke and TIA.

Results: Patients with cognitive impairment were older compared to patients without cognitive impairment (76±9 years, vs 69±9, p=0.001). There was no gender difference between the patients with or without cognitive impairment. Although 9 patients (32%) with stroke and TIA had cognitive impairment, 21 patients (40%) without stroke and TIA had cognitive impairment (p=0.468). While 12 patients (40%) with cognitive impairment were on beta blocker treatment, 30 patients (60%) without cognitive impairment were on beta blocker treatment (p=0.083). Although 25 patients (83%) with cognitive impairment were on statin treatment, 48 patients (96%) without cognitive impairment were on statin treatment (p=0.052). The OR for age was 0.892 and 95% CI 0.833-0.959, p=0.001 and the OR for usage of beta blocker was 0.289 and 95% CI 0.099-0.846, p=0.023.

Conclusion : Patients with stroke and TIA and patients without stroke and TIA had cognitive impairment in significant carotid artery disease. We speculate that some ischemic events are asymptomatic and remain undiagnosed. Beta blocker and statin usage might have a protective effect for cognition.