Asymptomatic cervicocerebral atherosclerosis, intracranial vascular resistance and cognition: the AsIA-neuropsychology study.
OBJECTIVE
Carotid atherosclerosis has emerged as a relevant contributor to cognitive impairment and dementia whereas the role of intracranial stenosis and vascular resistance in cognition remains unknown. This study aims to assess the association of asymptomatic cervicocerebral atherosclerosis and intracranial vascular resistance with cognitive performance in a large dementia-free population.


METHODS
The Barcelona-AsIA (Asymptomatic Intracranial Atherosclerosis) Neuropsychology Study included 747 Caucasian subjects older than 50 with a moderate-high vascular risk (assessed by REGICOR score) and without history of neither symptomatic vascular disease nor dementia. Extracranial and transcranial color-coded duplex ultrasound examination was performed to assess carotid intima-media thickness (IMT), presence of carotid plaques (ECAD group), intracranial stenosis (ICAD group), and middle cerebral artery pulsatility index (MCA-PI) as a measure of intracranial vascular resistance. Neuropsychological assessment included tests in three cognitive domains: visuospatial skills and speed, verbal memory and verbal fluency.


RESULTS
In univariate analyses, carotid IMT, ECAD and MCA-PI were associated with lower performance in almost all cognitive domains, and ICAD was associated with poor performance in some visuospatial and verbal cognitive tests. After adjustment for age, sex, vascular risk score, years of education and depressive symptoms, ECAD remained associated with poor performance in the three cognitive domains and elevated MCA-PI with worse performance in visuospatial skills and speed.


CONCLUSIONS
Carotid plaques and increased intracranial vascular resistance are independently associated with low cognitive functioning in Caucasian stroke and dementia-free subjects. We failed to find an independent association of intracranial large vessel stenosis with cognitive performance.
Department of Psychiatry and Clinical Psychobiology, Universitat de Barcelona, 08035 Barcelona, Spain; Institute for Brain, Cognition and Behavior (IR3C), Universitat de Barcelona, 08035 Barcelona, Spain.
Jorge
J
López-Olóriz
Elena
E
López-Cancio
Juan F
JF
Arenillas
María
M
Hernández
Marta
M
Jiménez
Laura
L
Dorado
Maite
M
Barrios
Juan José
JJ
Soriano-Raya
Júlia
J
Miralbell
Cynthia
C
Cáceres
Rosa
R
Forés
Guillem
G
Pera
Antoni
A
Dávalos
Maria
M
Mataró
D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D002340:Carotid Artery Diseases / Q000150:complications* / Q000473:pathology; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000150:complications* / Q000473:pathology; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000150:complications* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D009484:Neuropsychology; D018570:Risk Assessment; D020521:Stroke / Q000150:complications / Q000473:pathology; D014463:Ultrasonography; D014655:Vascular Resistance
Atherosclerosis; Cognitive impairment; Intima–media thickness; Intracranial stenosis; Pulsatility index