Clinical Study| Volume 20, ISSUE 11, P1571-1575, November 2013

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Carotid artery atherosclerosis is correlated with cognitive impairment in an elderly urban Chinese non-stroke population


      Carotid artery atherosclerosis may cause increased intima-media thickness (IMT), plaque formation, and vessel stenosis or occlusion. However, the association between carotid artery atherosclerosis and cognitive impairment remains uncertain. This study explored the effects of IMT and carotid artery stenosis on cognitive function in an elderly Chinese non-stroke population. A total of 2015 patients were recruited. The IMT of carotid arteries and the presence of plaques and stenosis in carotid arteries were assessed with B-mode ultrasound examination. Cognitive performance was evaluated with neuropsychological tests. The cross-sectional relationships between cognitive performance and carotid wall characteristics were analyzed. Carotid artery atherosclerosis (IMT > 1.0) and stenosis were found in 86% and 51% of patients, respectively. Cognitive impairment was found in 356 (17.7%) patients. After adjustment for possible confounders, IMT (odds ratio [OR] = 1.96; 95% confidence interval [CI] 1.23–3.16) and hyperdense plaque (OR = 4.72; 95% CI 2.56–11.2) were associated with poor cognitive performance. Patients with severe (⩾70%) carotid artery stenosis had a lower Mini-Mental State Examination score compared with the mild to modest (40–70%) carotid artery stenosis group. Cognitive performance differed between patients with left and right carotid artery stenosis, but no differences were observed between patients with severe left and right carotid artery stenosis. This study indicates that carotid artery atherosclerosis is correlated with cognitive impairment in the elderly Chinese population. A larger sample size across multiple centers and a longitudinal study are required to further explore the impact of carotid artery atherosclerosis on cognition in the elderly population.


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        • Qiu C.
        • De Ronchi D.
        • Fratiglioni L.
        The epidemiology of the dementias: an update.
        Curr Opin Psychiatry. 2007; 20: 380-385
        • Hachinski V.
        The 2005 Thomas Willis Lecture: stroke and vascular cognitive impairment: a transdisciplinary, translational and transactional approach.
        Stroke. 2007; 38: 1396-1403
        • Kearney-Schwartz A.
        • Rossignol P.
        • Bracard S.
        • et al.
        Vascular structure and function is correlated to cognitive performance and white matter hyperintensities in older hypertensive patients with subjective memory complaints.
        Stroke. 2009; 40: 1229-1236
        • Elias M.F.
        • Sullivan L.M.
        • D’Agostino R.B.
        • et al.
        Framingham stroke risk profile and lowered cognitive performance.
        Stroke. 2004; 35: 404-409
        • Touboul P.J.
        • Elbaz A.
        • Koller C.
        • et al.
        Common carotid artery intima-media thickness and brain infarction: the Etude du Profil Genetique de l’Infarctus Cerebral (GENIC) case-control study. The GENIC Investigators.
        Circulation. 2000; 102: 313-318
        • Cupini L.M.
        • Pasqualetti P.
        • Diomedi M.
        • et al.
        Carotid artery intima-media thickness and lacunar versus nonlacunar infarcts.
        Stroke. 2002; 33: 689-694
        • Weber F.
        The progression of carotid intima-media thickness in healthy men.
        Cerebrovasc Dis. 2009; 27: 472-478
        • Hofman A.
        • Ott A.
        • Breteler M.M.
        • et al.
        Atherosclerosis, apolipoprotein E, and prevalence of dementia and Alzheimer’s disease in the Rotterdam Study.
        Lancet. 1997; 349: 151-154
        • Mathiesen E.B.
        • Waterloo K.
        • Joakimsen O.
        • et al.
        Reduced neuropsychological test performance in asymptomatic carotid stenosis: the Tromso Study.
        Neurology. 2004; 62: 695-701
        • Pettigrew L.C.
        • Thomas N.
        • Howard V.J.
        • et al.
        Low mini-mental status predicts mortality in asymptomatic carotid arterial stenosis. Asymptomatic carotid atherosclerosis study investigators.
        Neurology. 2000; 55: 30-34
        • Johnston S.C.
        • O’Meara E.S.
        • Manolio T.A.
        • et al.
        Cognitive impairment and decline are associated with carotid artery disease in patients without clinically evident cerebrovascular disease.
        Ann Intern Med. 2004; 140: 237-247
        • Ebrahim S.
        • Papacosta O.
        • Whincup P.
        • et al.
        Carotid plaque, intima media thickness, cardiovascular risk factors, and prevalent cardiovascular disease in men and women: the British regional heart study.
        Stroke. 1999; 30: 841-850
      1. Saleh C. Carotid artery intima media thickness: a predictor of cognitive impairment? Front Biosci (Elite Ed) 2010;2:980–90.

        • Zhou H.
        • Deng J.
        • Li J.
        • et al.
        Study of the relationship between cigarette smoking, alcohol drinking and cognitive impairment among elderly people in China.
        Age Ageing. 2003; 32: 205-210
        • Touboul P.J.
        • Prati P.
        • Scarabin P.Y.
        • et al.
        Use of monitoring software to improve the measurement of carotid wall thickness by B-mode imaging.
        J Hypertens. 1992; 10: S37-S41
        • Auperin A.
        • Berr C.
        • Bonithon-Kopp C.
        • et al.
        Ultrasonographic assessment of carotid wall characteristics and cognitive functions in a community sample of 59- to 71-year-olds. The EVA study group.
        Stroke. 1996; 27: 1290-1295
        • Zhou D.H.
        • Wang J.Y.
        • Li J.
        • et al.
        Study on frequency and predictors of dementia after ischemic stroke: the Chongqing stroke study.
        J Neurol. 2004; 251: 421-427
        • Executive Committee for the Asymptomatic Carotid Atherosclerosis Study
        Endarterectomy for asymptomatic carotid artery stenosis.
        JAMA. 1995; 273: 1421-1428
        • Knopman D.
        • Boland L.L.
        • Mosley T.
        • et al.
        Cardiovascular risk factors and cognitive decline in middle-aged adults.
        Neurology. 2001; 56: 42-48
        • Wong T.Y.
        • Klein R.
        • Sharrett A.R.
        • et al.
        Retinal microvascular abnormalities and cognitive impairment in middle-aged persons: the atherosclerosis risk in communities study.
        Stroke. 2002; 33: 1487-1492
        • Cerhan J.R.
        • Folsom A.R.
        • Mortimer J.A.
        • et al.
        Correlates of cognitive function in middle-aged adults. Atherosclerosis Risk in Communities (ARIC) Study Investigators.
        Gerontology. 1998; 44: 95-105
        • Rockwood K.
        Vascular cognitive impairment and vascular dementia.
        J Neurol Sci. 2002; 203–204: 23-27
        • Dartigues J.F.
        • Gagnon M.
        • Mazaux J.M.
        • et al.
        Occupation during life and memory performance in nondemented French elderly community residents.
        Neurology. 1992; 42: 1697-1701
        • Stern Y.
        • Alexander G.E.
        • Prohovnik I.
        • et al.
        Inverse relationship between education and parietotemporal perfusion deficit in Alzheimer’s disease.
        Ann Neurol. 1992; 32: 371-375
        • Stern Y.
        • Albert S.
        • Tang M.X.
        • et al.
        Rate of memory decline in AD is related to education and occupation: cognitive reserve?.
        Neurology. 1999; 53: 1942-1947
        • Desmond D.W.
        • Moroney J.T.
        • Paik M.C.
        • et al.
        Frequency and clinical determinants of dementia after ischemic stroke.
        Neurology. 2000; 54: 1124-1131
        • Goldstein F.C.
        • Ashley A.V.
        • Endeshaw Y.W.
        • et al.
        Effects of hypertension and hypercholesterolemia on cognitive functioning in patients with Alzheimer’s disease.
        Alzheimer Dis Assoc Disord. 2008; 22: 336-342
        • Wolf P.A.
        • Abbott R.D.
        • Kannel W.B.
        Atrial fibrillation as an independent risk factor for stroke: the Framingham study.
        Stroke. 1991; 22: 983-988
        • Elwood P.C.
        • Pickering J.
        • Bayer A.
        • et al.
        Vascular disease and cognitive function in older men in the Caerphilly cohort.
        Age Ageing. 2002; 31: 43-48
        • Rockwood K.
        • Ebly E.
        • Hachinski V.
        • et al.
        Presence and treatment of vascular risk factors in patients with vascular cognitive impairment.
        Arch Neurol. 1997; 54: 33
        • de la Torre J.C.
        Critically attained threshold of cerebral hypoperfusion: can it cause Alzheimer’s disease?.
        Ann N Y Acad Sci. 2000; 903: 424-436
        • de la Torre J.C.
        The vascular hypothesis of Alzheimer’s disease:bench to bedside and beyond.
        Neurodegener Dis. 2010; 7: 116-121
        • Luzzi S.
        • Vella L.
        • Bartolini M.
        • et al.
        Atherosclerosis in the evolution of Alzheimer’s disease: can treatment reduce cognitive decline?.
        J Alzheimers Dis. 2010; 20: 893-901
        • Silvestrini M.
        • Viticchi G.
        • Falsetti L.
        • et al.
        The role of carotid atherosclerosis in Alzheimer’s disease progression.
        J Alzheimers Dis. 2011; 25: 719-726