title: Severe carotid stenosis and impaired cerebral hemodynamics can influence cognitive deterioration.
abstract: OBJECTIVE
  To evaluate whether severe carotid stenosis and related hemodynamics impairment may increase the risk of cognitive deterioration in asymptomatic subjects.
  
  
  METHODS
  A total of 210 subjects with unilateral asymptomatic severe carotid stenosis and 109 healthy controls were included and prospectively evaluated for a 36-month period. At entry, demographics, vascular risk profile, and pharmacologic treatments were defined. Cerebral hemodynamics was assessed by transcranial Doppler-based breath-holding index (BHI) test. Cognitive status was evaluated with the Mini-Mental State Examination (MMSE) at entry and at the end of the follow-up period. Cognitive deterioration was defined as a decrease in the MMSE score of 3 points or more during the overall follow-up period.
  
  
  RESULTS
  Subjects with carotid stenosis showed an increased probability of developing cognitive deterioration compared with the group without stenosis (odds ratio [OR] 4.16 [95% confidence interval (CI) 1.89-9.11]; p < 0.001). The presence of an impaired BHI ipsilateral to the stenosis was associated with an increased incidence of reduction in cognitive performance (OR 14.66 [95% CI 7.51-28.59]; p < 0.001).
  
  
  CONCLUSIONS
  Our findings show that the presence of a severe carotid stenosis influences cognitive deterioration over a 36-month period in asymptomatic subjects. An associated hemodynamic impairment significantly increases the risk. Evaluation of functional consequences of carotid stenosis may offer the opportunity to select a group with an increased risk of developing cognitive impairment from subjects with asymptomatic severe carotid stenosis.
authors.affiliation: Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Balestrini
authors.forename: Cecilia
authors.initials: C
authors.lastname: Perozzi
authors.forename: Claudia
authors.initials: C
authors.lastname: Altamura
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Vernieri
authors.forename: Simona
authors.initials: S
authors.lastname: Luzzi
authors.forename: Marco
authors.initials: M
authors.lastname: Bartolini
authors.forename: Leandro
authors.initials: L
authors.lastname: Provinciali
authors.forename: Mauro
authors.initials: M
authors.lastname: Silvestrini
mesh_terms: D000368:Aged; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000150:complications*; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D016017:Odds Ratio; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D017585:Ultrasonography, Doppler, Transcranial