title: Cognitive deterioration in bilateral asymptomatic severe carotid stenosis.
abstract: OBJECTIVE
  This study aimed to monitor cognitive performance during a 3-year period in subjects with bilateral asymptomatic severe internal carotid artery stenosis and to explore the role of cerebral hemodynamics and atherosclerotic disease in the development of cognitive dysfunction.
  
  
  METHODS
  One hundred fifty-nine subjects with bilateral asymptomatic severe internal carotid artery stenosis were included and prospectively evaluated for a 3-year period. At entry, demographics, vascular risk profile, and pharmacological treatments were defined. Cognitive status was evaluated using the Mini-Mental State Examination at baseline and at follow-up. Cerebral hemodynamics was assessed by transcranial Doppler-based breath-holding index test. As a measure of the extent of systemic atherosclerotic disease, common carotid artery intima-media thickness was measured. A cutoff for pathological values was set at 0.69 for breath-holding index and 1.0 mm for intima-media thickness.
  
  
  RESULTS
  The risk of decreasing in Mini-Mental State Examination score increased progressively from patients with bilaterally normal to those with unilaterally abnormal breath-holding index, reaching the highest probability in patients with bilaterally abnormal breath-holding index (P<0.0001). Pathological values of intima-media thickness did not influence the risk of Mini-Mental State Examination score change.
  
  
  CONCLUSIONS
  Our findings suggest that patients with asymptomatic bilateral severe internal carotid artery stenosis may be at risk of developing cognitive impairment. The evaluation of the hemodynamic status, besides providing insights about the possible mechanism behind the cognitive dysfunction present in carotid atherosclerotic disease, may be of help for the individuation of subjects deserving earlier and more aggressive treatments.
authors.affiliation: From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.).
authors.forename: Laura
authors.initials: L
authors.lastname: Buratti
authors.affiliation: From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.).
authors.forename: Clotilde
authors.initials: C
authors.lastname: Balucani
authors.affiliation: From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.).
authors.forename: Giovanna
authors.initials: G
authors.lastname: Viticchi
authors.affiliation: From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.).
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Falsetti
authors.affiliation: From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.).
authors.forename: Claudia
authors.initials: C
authors.lastname: Altamura
authors.affiliation: From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.).
authors.forename: Emma
authors.initials: E
authors.lastname: Avitabile
authors.affiliation: From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.).
authors.forename: Leandro
authors.initials: L
authors.lastname: Provinciali
authors.affiliation: From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.).
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Vernieri
authors.affiliation: From the Neurological Clinic, Marche Polytechnic University, Ancona, Italy (L.B., G.V., E.A., L.P., M.S.); Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY (C.B.); Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Ancona, Italy (L.F.); and Neurology Unit, Campus Bio-Medico University, Rome, Italy (C.A., F.V.). m.silvestrini@univpm.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Silvestrini
mesh_terms: D000368:Aged; D001921:Brain / Q000098:blood supply / Q000503:physiopathology*; D059168:Carotid Intima-Media Thickness / Q000295:instrumentation; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D011569:Psychiatric Status Rating Scales; D012306:Risk; D012720:Severity of Illness Index; D017585:Ultrasonography, Doppler, Transcranial
keywords: carotid stenosis; mild cognitive impairment; ultrasonography