Abstract
To investigate potential associations between carotid artery stenosis and cognitive impairment among patients with acute ischemic stroke and to provide important clinical implications. We measured the degree of carotid artery stenosis and recorded the Mini-Mental State Examination score (MMSE) at admission in 3116 acute ischemic stroke patients. The association between carotid stenosis and cognitive impairment assessed by MMSE was tested using multivariate regression analysis. Other clinical variables of interest were also studied. After adjusting for age, gender, education level, marriage, alcohol use, tobacco use, physical activity, hypertension, diabetes, hypercholesterolemia, atrial fibrillation, myocardial infarction and NIHSS (National Institutes of Health Stroke Scale) score, we found that participants with high-grade stenosis of the carotid artery had a higher likelihood of cognitive impairment compared to those without carotid artery stenosis (OR = 1.49, 95%CI: 1.05–2.11, p<0.001). Left common carotid artery stenosis was associated with cognitive impairment in the univariate analysis, although this effect did not persist after adjustment for the NIHSS score. Cognitive impairment was associated with high-grade stenosis of the right carotid artery.
Highlights
Cognitive impairment is an important public health problem
Studies investigating the association between carotid atherosclerosis and cognitive impairment have been performed in Western countries [8,9,10,11] and have demonstrated that carotid atherosclerosis may be a potential risk factor for cognitive impairment in elderly people
The inclusion criteria for SOS-Stroke were as follows: (1) patient age over 18 years; (2) neurologistdiagnosed acute ischemic stroke that was confirmed with computed tomography (CT) or magnetic resonance imaging (MRI); (3) time from initial stroke to diagnosis less than two weeks; and (4) patient-provided informed consent
Summary
Cognitive impairment is an important public health problem. The worldwide incidence of Alzheimer’s disease is estimated to be >35 million cases, and the total estimated global costs of dementia amounted to US$604 billion in 2010 [1]. Cardiovascular risk factors have been suggested to play important roles in cognitive decline and dementias including Alzheimer’s disease [2,3,4,5,6,7]. Studies investigating the association between carotid atherosclerosis and cognitive impairment have been performed in Western countries [8,9,10,11] and have demonstrated that carotid atherosclerosis may be a potential risk factor for cognitive impairment in elderly people. Carotid IMT scores have been shown to be associated with cognitive decline in stroke-free individuals [12,13,14,15,16,17,18,19]. Prior epidemiological studies have indicated associations between carotid IMT, stenosis and cognitive decline in stroke-free individuals [8,9,10,11]. The results of recent studies have not been consistent in these associations [13, 20,21,22,23,24,25], and few large multi-center studies have been performed
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