title: Impaired Cerebral Hemodynamics and Cognitive Performance in Patients with Atherothrombotic Disease.
abstract: OBJECTIVE
  Patients with pre-existing atherothrombotic disease are prone to cognitive impairment. We tested whether impaired cerebrovascular reactivity (CVR), a marker of cerebral microvascular hemodynamic dysfunction, is associated with poorer cognitive scores among patients with and without carotid large-vessel disease.
  
  
  METHODS
  A subgroup of non-demented patients with chronic coronary heart disease followed-up for 15 ± 3 years was assessed for cognitive function (Neurotrax Computerized Cognitive Battery; scaled to an IQ style scale with a mean of 100 and SD of 15) and for CVR using the breath-holding index (BHI) with transcranial Doppler and for carotid plaques using ultrasound. We assessed cognitive scores in specific domains in patients with and without impaired CVR (BHI <0.47; bottom quartile).
  
  
  RESULTS
  Among 415 patients (mean age 71.7 ± 6.2 y) median BHI was 0.73 (25% 0.47, 75% 1.04). Impaired CVR was associated with diabetes and peripheral artery disease. Adjusting for potential confounders, impaired CVR was associated with lower executive function (p = 0.02) and global cognitive scores (p = 0.04). There was an interaction with carotid large-vessel disease for executive function (p <  0.001), memory (p = 0.03), and global cognitive scores (p = 0.02). In the carotid large-vessel disease group there were pronounced differences by CVR status in executive function (p <  0.001), memory (p = 0.02), attention (p <  0.001), and global cognitive scores (p = 0.001).
  
  
  CONCLUSIONS
  Impaired CVR, a marker of cerebral microvascular dysfunction, is associated with poorer cognitive functions and in particular executive dysfunction among non-demented patients with concomitant carotid large-vessel disease. These findings emphasize the importance of cerebral hemodynamics in cognitive performance.
authors.affiliation: The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.|Department of Neurology, Hospital das Clínicas, São Paulo University, São Paulo, Brazil.
authors.forename: Salo
authors.initials: S
authors.lastname: Haratz
authors.affiliation: Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Galit
authors.initials: G
authors.lastname: Weinstein
authors.affiliation: The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Noa
authors.initials: N
authors.lastname: Molshazki
authors.affiliation: The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.|Department of Psychiatry at the Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Michal Schnaider
authors.initials: MS
authors.lastname: Beeri
authors.affiliation: The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Ramit
authors.initials: R
authors.lastname: Ravona-Springer
authors.affiliation: The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Oleg
authors.initials: O
authors.lastname: Marzeliak
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Goldbourt
authors.affiliation: The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.|Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Tanne
mesh_terms: D000368:Aged; D001629:Bezafibrate / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002560:Cerebrovascular Circulation / Q000187:drug effects; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000188:drug therapy; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D000069336:Neurovascular Coupling / Q000502:physiology*; D014463:Ultrasonography
chemical_list: D000960:Hypolipidemic Agents; D001629:Bezafibrate
keywords: Cerebrovascular disorders; dementia; hemodynamics; transcranial Doppler sonography; vascular dementia