title: Thresholds of impaired cerebral hemodynamics that predict short-term cognitive decline in asymptomatic carotid stenosis.
abstract: Subjects with asymptomatic carotid stenosis (ACS) may be at risk of cognitive impairment due to cerebral hypoperfusion. In this study, we aimed to detect a threshold of cerebral hemodynamics which is able to identify subjects at risk of cognitive deterioration. In subjects with ACS, cerebral vasomotor reactivity (CVR) was assessed with the breath-holding index (BHI) transcranial Doppler-based method. Cognitive deterioration was defined as a decrease in the MMSE score by ≥2 points after one year. In order to define the threshold of impaired BHI, a ROC curve analysis was performed adopting the binary difference of MMSE score as the outcome and continuous BHI as the testing variable. A total of 548 subjects completed the follow-up. Cognitive deterioration was observed in 119 patients (21.7%). The BHI value ipsilateral to the stenosis was the strongest predictor of cognitive deterioration among the variables tested. The best cut-point to discriminate between normal and abnormal BHI resulted ≤0.89. The post-test probability of cognitive deterioration for an abnormal BHI was 44%, while a normal BHI showed a post-test probability of 9% for the same outcome. The present investigation provides a threshold of reduced CVR that can be useful to identify subjects with ACS at risk of cognitive deterioration.
authors.affiliation: Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Buratti
authors.affiliation: Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Viticchi
authors.affiliation: Internal and Subintensive Medicine, Ospedali Riuniti Ancona, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Falsetti
authors.affiliation: Neurological Clinic, Marche Polytechnic University, Ancona, Italy Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Clotilde
authors.initials: C
authors.lastname: Balucani
authors.affiliation: Neurology Unit, Campus Bio-Medico University, Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Altamura
authors.affiliation: Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Petrelli
authors.affiliation: Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
authors.forename: Leandro
authors.initials: L
authors.lastname: Provinciali
authors.affiliation: Neurology Unit, Campus Bio-Medico University, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Vernieri
authors.affiliation: Neurological Clinic, Marche Polytechnic University, Ancona, Italy m.silvestrini@univpm.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Silvestrini
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017585:Ultrasonography, Doppler, Transcranial
keywords: Carotid artery; cerebral hemodynamics; cognitive impairment; risk factors; ultrasound