title: A review of carotid atherosclerosis and vascular cognitive decline: a new understanding of the keys to symptomology.
abstract: This review encourages the reader to consider cerebral vascular disease beyond the traditional clinical end points of major motor and speech strokes and to consider the possible impact of embolic cerebral vascular disease on vascular cognitive decline. This article examines the issue of "silent" strokes in the relationship between the structural stability of atherosclerotic carotid plaque and the development of nonmotor symptomatology, including cognitive decline. It addresses the question of the role of carotid emboli in silent stroke and their cognitive sequelae. In a study of endarterectomy patients, we relate plaque elasticity and its development of mechanical strain features and thinning of stabilizing fibrous cap at the point of these mechanical strain features. The possibility that microemboli from such mechanically unstable carotid plaques could contribute to silent strokes led to a study of cognitive function in such patients. A linear relationship between the process of mechanically unstable areas of carotid plaques and cognitive decline suggests a contributory role for such a process in silent strokes.
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Department of Neurological Surgery, Madison, Wisconsin 53792, USA. dempsey@neurosurg.wisc.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Dempsey
authors.forename: Raghu
authors.initials: R
authors.lastname: Vemuganti
authors.forename: Tomy
authors.initials: T
authors.lastname: Varghese
authors.forename: Bruce P
authors.initials: BP
authors.lastname: Hermann
mesh_terms: D002340:Carotid Artery Diseases / Q000150:complications* / Q000235:genetics / Q000523:psychology*; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology* / Q000523:psychology*; D004548:Elasticity; D004621:Embolization, Therapeutic; D015870:Gene Expression; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000473:pathology; D009389:Neovascularization, Pathologic / Q000473:pathology; D009483:Neuropsychological Tests; D058226:Plaque, Atherosclerotic / Q000209:etiology / Q000473:pathology; D020521:Stroke / Q000523:psychology