J Clin Neurol.  2007 Mar;3(1):9-17. 10.3988/jcn.2007.3.1.9.

Cognitive Dysfunction in 16 Patients with Carotid Stenosis: Detailed Neuropsychological Findings

Affiliations
  • 1Department of Neurology, Konyang University College of Medicine, Daejeon, Korea. jekim220@medimail.co.kr
  • 2Department of Neurology, Eulji University Hospital, Korea.
  • 3Department of Radiology, Eulji University Hospital, Korea.
  • 4Department of Neurology, Seoul National University College of Medicine, Korea.

Abstract

BACKGROUND
Impairment of cognitive function is often present in patients with carotid artery stenosis but the details of this dysfunction have rarely been reported. Our purpose was to elucidate the cognitive dysfunction in patients with unilateral severe carotid stenosis using comprehensive neuropsychological testing, and also to identify the specific underlying clinical and radiological factors.
METHODS
We analyzed the results of neuropsychological testing, the clinical history, and MR findings in 16 consecutive patients with angiographically proven severe (70-99%) stenosis of the extra cranial internal carotid artery (ICA). Cognitive functions were examined using the Seoul Neuropsychological Screening Battery and the Neglect Battery. We excluded patients with cortical infarction and those with contra lateral ICA occlusion or severe stenosis.
RESULTS
Our comprehensive neuropsychological testing revealed obvious cognitive deficits in all patients with unilateral severe ICA stenosis, the most common being frontal executive impairment. The mean cognitive score on the memory test was also significantly lower in patients with symptomatic ICA stenosis than in asymptomatic patients (29.33+/-10.98, mean+/-SD, p < 0.05). The total score on the global cognitive test was significantly lower in patients with an ischemic lesion on MRI than in no lesion patients (113.23+/-34.78, p < 0.05). The presence of symptoms related to the ICA stenosis was related to cognitive dysfunction even when there were no ischemic lesions on MRI. SPECT revealed ipsilateral cortical hypoperfusion in 9 of 12 patients (75%).
CONCLUSIONS
Cognitive deficits are common in patients with unilateral severe ICA stenosis. Our findings suggest that an additional mechanism beyond the structural lesion such as chronic hypoperfusion may affect cognitive function in patients with high-grade ICA stenosis.

Keyword

Minor stroke; ICA stenosis; Neuropsychological test; Chronic hypoperfusion

MeSH Terms

Carotid Artery, Internal
Carotid Stenosis*
Constriction, Pathologic
Humans
Infarction
Magnetic Resonance Imaging
Mass Screening
Memory
Neuropsychological Tests
Seoul
Tomography, Emission-Computed, Single-Photon

Figure

  • Figure 1 Images obtained in a 65-year-old man with a minor completed stroke. (A) FLAIR image showing small ischemic lesions in the left deep white-matter area. (B) Carotid angiogram showing severe stenosis of the proximal internal carotid artery as measured by the NASCET method.


Cited by  4 articles

Effect of Carotid Artery Stenting on Cognitive Function in Patients with Carotid Artery Stenosis: A Prospective, 3-Month-Follow-Up Study
Byeol-A Yoon, Sang Wuk Sohn, Sang-Myung Cheon, Dae-Hyun Kim, Jae-Kwan Cha, SoJeong Yi, Kyung Won Park
J Clin Neurol. 2015;11(2):149-156.    doi: 10.3988/jcn.2015.11.2.149.

Gradient-Echo MRI in Defining the Severity of Cerebral Fat Embolism
Jun Lee
J Clin Neurol. 2008;4(4):164-166.    doi: 10.3988/jcn.2008.4.4.164.

Citicoline Protects Against Cognitive Impairment in a Rat Model of Chronic Cerebral Hypoperfusion
Hyun Joon Lee, Ji Seung Kang, Yeong In Kim
J Clin Neurol. 2009;5(1):33-38.    doi: 10.3988/jcn.2009.5.1.33.

Is High IQ Protective Against Cognitive Dysfunction in Narcoleptic Patients?
So-Mee Yoon, Eun Yeon Joo, Ji Young Kim, Kyoung Jin Hwang, Seung Bong Hong
J Clin Neurol. 2013;9(2):118-124.    doi: 10.3988/jcn.2013.9.2.118.


Reference

1. Inzitari D, Eliasziw M, Sharpe BL, Fox AJ, Barnett HJ. Risk factors and outcome of patients with carotid artery stenosis presenting with lacunar stroke. North American Symptomatic Carotid Endarterectomy Trial Group. Neurology. 2000. 54:660–666.
Article
2. Inzitari D, Eliasziw M, Gates P, Sharpe BL, Chan RK, Meldrum HE, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 2000. 342:1693–1700.
Article
3. Eliasziw M, Kennedy J, Hill MD, Buchan AM, Barnett HJ. North American Symptomatic Carotid Endarterectomy Trial Group. Early risk of stroke after a transient ischemic attack in patients with internal carotid artery disease. CMAJ. 2004. 170:1105–1109.
Article
4. Yamauchi H, Fukuyama H, Nagahama Y, Oyanagi C, Okazawa H, Ueno M, et al. Long-term changes of hemodynamics and metabolism after carotid artery occlusion. Neurology. 2000. 54:2095–2102.
Article
5. Klijn CJM, Kappelle LJ, Tulleken CAF, van Gijn J. Symptomatic carotid artery occlusion. A reappraisal of hemodynamic factors. Stroke. 1997. 28:2084–2093.
6. Fisher M, Martin A, Cosgrove M, Norris JW. The NASCETACAS plaque project. North American Symptomatic Carotid Endarterectomy Trial. Asymptomatic Carotid Atherosclerosis Study. Stroke. 1993. 24:I24–I25.
7. Bakker FC, Klijn CJM, Jennekens-Schinkel A, Kappelle LJ. Cognitive disorders in patients with occlusive disease of the carotid artery: a systemic review of the literature. J Neurol. 2000. 247:669–676.
Article
8. Mathiesen EB, Waterloo K, Joakimsen O, Bakke SJ, Jacobsen EA, Bonaa KH. Reduced neuropsychological test performance in asymptomatic carotid stenosis:The Tromso Study. Neurology. 2004. 62:695–701.
Article
9. Pettigrew LC, Thomas N, Howard VJ, Veltkamp R, Toole JF. Low mini-mental status predicts mortality in asymptomatic carotid arterial stenosis. Asymptomatic Carotid Atherosclerosis Study investigators. Neurology. 2000. 55:30–34.
10. Bakker FC, Klijn CJM, van der Grond J, Kappelle LJ, Jennekens-Schinkel AJ. Cognition and quality of life in patients with carotid artery occlusion: a follow-up study. Neurology. 2004. 62:2230–2235.
Article
11. Rao R. The role of carotid stenosis in vascular cognitive impairment. Eur Neurol. 2001. 46:63–69.
Article
12. Hamster W, Diener HC. Neuropsychological changes associated with stenoses or occlusions of the carotid arteries. A comparative psychometric study. Eur Arch Psychiatry Neurol Sci. 1984. 234:69–73.
Article
13. Naugle RI, Bridger's SL, Delaney RC. Neuropsychological signs of asymptomatic carotid stenosis. Arch Clin Neuropsychol. 1986. 1:25–30.
Article
14. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991. 325:445–453.
15. Van den Burg W, Saan RJ, Van Zomeren AH, Boontje JH, Haaxma R, Wichmann TE. Carotid endarterectomy: does it improve cognitive or motor functioning? Psycho Med. 1985. 15:341–346.
Article
16. Tejada J, Diez-Tejedor E, Hernandez-Echebarria L, Balboa O. Does a relationship exist between carotid stenosis and lacunar infarction? Stroke. 2003. 34:1404–1409.
Article
17. Reed BR, Eberling JL, Mungas D, Weiner M, Kramer JH, Jagust WJ. Effects of white matter lesions and lacunar on cortical function. Arch Neurol. 2004. 61:1545–1550.
Article
18. Tullberg M, Fletcher E, DeCarli C, Mungas D, Reed BR, Harvey DJ, et al. White matter lesions impair frontal lobe function regardless of their location. Neurology. 2004. 63:246–253.
Article
19. Bakker FC, Klijn CJM, Jennekins-Schinkel A, van der Tweel I, van der Grond J, van Huffelen AC, et al. Cognitive impairment is related to cerebral lactate in patients with carotid artery occlusion and ipsilateral transient ischemic attacks. Stroke. 2003. 34:1419–1424.
Article
20. King GD, Gideon DA, Haynes CD, Dempsey RL, Jenkins CW. Intellectual and personality changes associated with carotid endarterectomy. J Clin Psychol. 1977. 33:215–220.
Article
21. Hemmingsen R, Mejsholm B, Vorstrup S, Lester J, Engell HC, Boysen G. Carotid surgery, cognitive function, and cerebral blood flow in patients with transient ischemic attacks. Ann Neurol. 1986. 20:13–19.
Article
22. Kelly MP, Garron DC, Javid H. Carotid artery disease, carotid endarterectomy, and behavior. Arch Neurol. 1980. 37:743–748.
Article
23. Irvine CD, Gardner FV, Davies AH, Lamont PM. Cognitive testing in patients undergoing carotid endarterectomy. Eur J Vasc Endovasc Surg. 1998. 15:195–204.
Article
24. Lunn S, Crawley F, Harrison MJ, Brown MM, Newman SP. Impact of carotid endarterectomy upon cognitive functioning. A systematic review of the literature. Cerebrovasc Dis. 1999. 9:74–81.
Article
25. Heyer EJ, Adams DC, Solomon RA, Todd GJ, Quest DO, McMahon DJ, et al. Neuropsychometric changes in patients after carotid endarterectomy. Stroke. 1998. 29:1110–1115.
Article
26. Ballard CG, Burton EJ, Barber R, Stephens S, Kenny RA, Kalaria RN, et al. NINDS AIREN neuroimaging criteria do not distinguish stroke patients with and without dementia. Neurology. 2004. 63:983–988.
Article
27. Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M. Dementia three months after stroke Baseline frequency and effect of different definitions of dementia in the Helsinki Stroke Aging Memory Study (SAM) cohort. Stroke. 1997. 28:785–792.
28. Iddon JL, Sahakian BJ, Kirkpatrick PJ. Uncomplicated carotid endarterectomy is not associated with neuropsychological impairment. Pharmacol Biochem Behav. 1997. 56:781–787.
Article
Full Text Links
  • JCN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr