Asymptomatic Carotid Disease and Cognitive Impairment: What Is the Evidence?

Hediyeh Baradaran,Amir Hossein Sarrami,Ajay Gupta

doi:10.3389/fneur.2021.741500

Abstract

The development of cognitive dysfunction and dementia is a complex, multifactorial process. One of the contributors to various types of cognitive dysfunction is carotid atherosclerosis which can frequently be seen in asymptomatic individuals. There are a number of different manifestations of asymptomatic carotid atherosclerosis including arterial stiffness, carotid intima-media thickening, flow-limiting stenosis, and complex, atherosclerotic plaque. Each of these forms of atherosclerosis may contribute to cerebral parenchymal damage, contributing to cognitive dysfunction. In this review article, we will discuss each of these forms of carotid atherosclerosis, present the potential mechanistic underpinnings behind an association, and then review the scientific evidence supporting potential associations to cognitive dysfunction and dementia.

Highlights

With an ever-increasing aging world population, there is increasing demand for identifying effective preventative and treatment strategies for the development of dementia and cognitive dysfunction [1]
One of the factors that appears to be contributing to the development of cognitive dysfunction and dementia is carotid atherosclerotic disease, including carotid stiffness, increased carotid intima media thickness, flow-limiting carotid stenosis, and high-risk carotid plaque features [2, 3]
We performed a robust search of the available medical literature searching for manuscripts with key terms related to carotid atherosclerosis, carotid stenosis, arterial stiffness, and carotid plaque along with any terms related to cognitive impairment, dysfunction, or dementia

Summary

INTRODUCTION

With an ever-increasing aging world population, there is increasing demand for identifying effective preventative and treatment strategies for the development of dementia and cognitive dysfunction [1]. One of the factors that appears to be contributing to the development of cognitive dysfunction and dementia is carotid atherosclerotic disease, including carotid stiffness, increased carotid intima media thickness, flow-limiting carotid stenosis, and high-risk carotid plaque features [2, 3]. While traditionally thought to primarily contribute to ischemic stroke, there is increasing evidence of the contribution of carotid atherosclerotic disease to the development of cognitive impairment and dementia. Though there are many contributing factors in the development of dementia, in this review, we will focus on the role of asymptomatic carotid artery atherosclerosis in contributing to cognitive dysfunction and dementia (Figure 1). We will discuss the evidence supporting an association between flowlimiting extracranial carotid stenosis and cognitive impairment. We will review the relevant evidence behind specific carotid plaque features in the development of mild cognitive impairment and dementia

SEARCH METHODS FOR REVIEW

Findings

CONCLUSION