title: Cognitive and emotional effects of carotid stenosis.
abstract: BACKGROUND
  Patients with carotid artery stenosis (CAS) are at risk of ipsilateral stroke and chronic compromise of cerebral blood flow. It is under debate whether the hypo-perfusion or embolism in CAS is directly related to cognitive impairment. Alternatively, CAS may be a marker for underlying risk factors, which themselves influence cognition. We aimed to determine cognitive performance level and the emotional state of patients with CAS. We hypothesised that patients with high grade stenosis, bilateral stenosis, symptomatic patients and/or those with relevant risk factors would suffer impairment of their cognitive performance and emotional state.
  
  
  METHODS
  A total of 68 patients with CAS of ≥70% were included in a prospective exploratory study design. All patients underwent structured assessment of executive functions, language, verbal and visual memory, motor speed, anxiety and depression.
  
  
  RESULTS
  Significantly more patients with CAS showed cognitive impairments (executive functions, word production, verbal and visual memory, motor speed) and anxiety than expected in a normative sample. Bilateral and symptomatic stenosis was associated with slower processing speed. Cognitive performance and anxiety level were not influenced by the side and the degree of stenosis or the presence of collaterals. Factors associated with less cognitive impairment included higher education level, female gender, ambidexterity and treated hypercholesterolemia.
  
  
  CONCLUSIONS
  Cognitive impairment and increased level of anxiety are frequent in patients with carotid stenosis. The lack of a correlation between cognitive functioning and degree of stenosis or the presence of collaterals, challenges the view that CAS per se leads to cognitive impairment.
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, Bern, Switzerland; Center for Cognition, Learning and Memory, University of Bern, Switzerland; Division of Neuropediatrics, Development and Rehabilitation, Childr.
authors.forename: Regula
authors.initials: R
authors.lastname: Everts
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, Bern, Switzerland; Center for Cognition, Learning and Memory, University of Bern, Switzerland.
authors.forename: Manuela
authors.initials: M
authors.lastname: Wapp
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, Bern, Switzerland; University Hospital of Psychiatry, University of Bern, Switzerland.
authors.forename: Yuliya
authors.initials: Y
authors.lastname: Burren
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, Bern, Switzerland.
authors.forename: Frauke
authors.initials: F
authors.lastname: Kellner-Weldon
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, Bern, Switzerland.
authors.forename: Marwan
authors.initials: M
authors.lastname: El-Koussy
authors.affiliation: Department of Psychiatric Neurophysiology, University of Bern, Switzerland.
authors.forename: Kay
authors.initials: K
authors.lastname: Jann
authors.affiliation: Rehabilitation and Neuropsychology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
authors.forename: Jessica
authors.initials: J
authors.lastname: Delameilluer Lenoir
authors.affiliation: Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, Bern, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology*; D060825:Cognitive Dysfunction / Q000209:etiology*; D003863:Depression / Q000209:etiology; D004522:Educational Status; D004644:Emotions; D056344:Executive Function; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007802:Language; D008297:Male; D061212:Memory, Episodic; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011930:Reaction Time; D012737:Sex Factors; D014463:Ultrasonography