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Zhang N, Xie B, Feng Y, Li Q, Li X. Effects of asymptomatic cerebral artery stenosis of anterior circulation and establishment of collateral circulation on cognition. Clin Neurol Neurosurg 2023; 233:107889. [PMID: 37515853 DOI: 10.1016/j.clineuro.2023.107889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/03/2023] [Accepted: 07/09/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE The purpose of this study is to investigate how cognition is affected by asymptomatic cerebral artery stenosis (CAS) of the anterior circulation and its related collateral circulation. METHODS 102 patients with CAS of the anterior circulation and 52 controls were enrolled from January 1, 2019 to June 30, 2022. Patients with CAS of anterior circulation were further divided into different subgroups according to the degree of stenosis, cerebral perfusion, and collateral circulation. A series of neuropsychological scales were used to evaluate the participant's cognitive function, activities of daily living, and neuropsychiatric symptoms (such as memory, execution, psychomotor speed, etc.). The data were analyzed using T-test, F-test, chi-square test, rank sum test, and other statistical methods, moreover, the quantitative data were further examined for trends. The relationship between the degree of CAS, cerebral perfusion, collateral circulation, and the outcome of the cognitive test was investigated using Spearman correlation analysis. RESULTS Compared to controls, there were severe impairments of global cognition, psychomotor speed/execution, memory, attention, activities of daily living, and more neuropsychiatric symptoms in patients with anterior circulation CAS (p < 0.05), and these impairments got worsened with the aggravation of CAS (p < 0.05). The global cognition, psychomotor speed / executive function, memory function, and daily living ability were impaired both in the cerebral perfusion-compensated group and decompensated group(p < 0.05), while there was no statistically significant difference between the two groups (p > 0.05). With the aggravation of CAS, the proportion of poor collateral formation increased, and this difference was statistically significant (P < 0.01). The degree of stenosis, cerebral perfusion, and collateral circulation establishment of anterior circulation CAS was correlated with global cognition, memory, psychomotor speed, execution, attention, activities of daily living, and neuropsychiatric symptoms (all p < 0.01). CONCLUSION Cognitive impairment and the percentage of inadequate collateral circulation development rise as stenosis progresses in patients with anterior circulation CAS. The decline in global cognitive function was accompanied by impairments in psychomotor speed / executive function, memory function, attention, and daily living skills, as well as the aggravation of neuropsychiatric symptoms, especially in patients with impaired cerebral perfusion and poor collateral circulation formation.
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Affiliation(s)
- Nan Zhang
- Department of Neurology, The second affiliated hospital of Chongqing Medical University, Chongqing, China
| | - Binbin Xie
- Department of Neurology, The second affiliated hospital of Chongqing Medical University, Chongqing, China
| | - Yuxue Feng
- Department of Neurology, The second affiliated hospital of Chongqing Medical University, Chongqing, China
| | - Qin Li
- Department of Neurology, The second affiliated hospital of Chongqing Medical University, Chongqing, China
| | - Xiaofeng Li
- Department of Neurology, The second affiliated hospital of Chongqing Medical University, Chongqing, China.
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Piegza M, Dębski P, Bujak K, Jaworska I, Gorczyca P, Pudlo R, Żerdziński M, Piegza J. Cognitive functions and sense of coherence in patients with carotid artery stenosis-Preliminary report. Front Psychiatry 2023; 14:1237130. [PMID: 37817831 PMCID: PMC10560880 DOI: 10.3389/fpsyt.2023.1237130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Background There is scarcely any data in the available literature on the relationship between sense of coherence (SOC) and cognitive functioning, and no information on the relationship between SOC and cognitive parameters in patients with carotid atherosclerosis. Aim The aim of this paper was to determine the relationship of SOC measured prior to carotid artery stenting (CAS) with neurocognitive functioning in patients with carotid atherosclerosis 12 months after CAS. Methods A total of 35 patients with carotid atherosclerosis completed the SOC-29 Orientation to Life Questionnaire (SOC-29) and completed a cognitive test battery twice, i.e., before (baseline-T1) and 12 months after stent implantation (follow-up-T2). Selected cognitive functions such as memory, attention, perception, visuospatial and executive functions and non-verbal fluency were assessed. Results One year after the procedure, patients with a higher SOC and sense of manageability present better performance in visual memory. Higher SOC and sense of meaningfulness are positively related to the speed of understanding the changing rules of card sorting (WCST). Conclusion Higher overall SOC and a component of sense of meaningfulness and manageability may be related to better cognitive functioning 1 year after the procedure.
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Affiliation(s)
- Magdalena Piegza
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Tarnowskie Gory, Poland
| | - Paweł Dębski
- Institute of Psychology, Faculty of Social Sciences and Humanities, Humanitas University in Sosnowiec, Sosnowiec, Poland
| | - Kamil Bujak
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Izabela Jaworska
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Piotr Gorczyca
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Tarnowskie Gory, Poland
| | - Robert Pudlo
- Department of Psychoprophylaxis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Tarnowskie Gory, Poland
| | - Maciej Żerdziński
- Faculty of Medicine, Academy of Silesia, Katowice, Poland
- Department of Psychiatry, Dr. Krzysztof Czuma’s Psychiatric Center, Katowice, Poland
| | - Jacek Piegza
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Silesian Center for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
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Succar B, Zhou W. Does Carotid Intervention Improve Cognitive Function? Adv Surg 2023; 57:267-277. [PMID: 37536858 DOI: 10.1016/j.yasu.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Carotid artery disease has been linked to baseline cognitive impairment, even in asymptomatic patients. Therefore, there has been a persistent interest in investigating the impact of carotid revascularization on cognitive functions, but the results have been heterogeneous. Our recent prospective evaluation showed improved cognitive scores across multiple cognitive measures following carotid intervention. Herein, we summarize the studies published to date, identify the potential contributors to the inconsistency of post-interventional cognitive outcomes, and explore further opportunities in cognitive evaluations.
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Affiliation(s)
- Bahaa Succar
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Wei Zhou
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA.
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Miyake S, Takahashi K, Nakai Y, Amano Y, Yamamoto R, Amari K, Hara H, Johkura K. Visual suppression of vestibulo-ocular reflex in patients treated with carotid artery revascularization: A potential biomarker for cerebral perfusion. J Neurol Sci 2023; 445:120534. [PMID: 36587563 DOI: 10.1016/j.jns.2022.120534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are common treatments for ischemic stroke prevention in patients with carotid artery stenosis. However, the beneficial effects of CEA/CAS for cerebral hypoperfusion due to carotid artery stenosis have yet to be fully established. As dizziness is a common symptom in patients with carotid artery stenosis, we aimed to evaluate the effects of CEA/CAS on cerebral function in patients with carotid artery stenosis, using equilibrium function tests. METHODS This prospective observational cohort study included 50 patients who had carotid artery stenosis and were scheduled to undergo CEA or CAS. Before CEA/CAS, we quantitatively evaluated the vestibulo-ocular reflex (VOR) and vestibular evoked myogenic potential (VEMP), as indicators of brainstem/inner ear functions related to balance, and visual suppression of VOR, as an indicator of cerebral control over the brainstem reflex related to balance. These were then compared with supratentorial cerebral blood flow (CBF). Changes in VOR, VEMP, visual suppression of VOR, CBF, and dizziness after CEA/CAS were also evaluated. RESULTS The visual suppression rates of VOR correlated with supratentorial CBFs before CEA/CAS (correlation coefficient = 0.47, p = 0.003). The visual suppression rates of VOR (p < 0.001) and supratentorial CBFs (p = 0.003) were improved by CEA/CAS, while VOR and VEMP did not change. Symptoms of dizziness improved after CEA/CAS. CONCLUSIONS Our results suggest that visual suppression of the VOR may be a novel and practical marker for the beneficial effects of CEA/CAS on supratentorial cerebral function.
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Affiliation(s)
- Shigeta Miyake
- Department of Neurosurgery, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Koji Takahashi
- Department of Clinical Laboratory, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Yasunobu Nakai
- Department of Neurosurgery, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Yu Amano
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Ryoo Yamamoto
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Kazumitsu Amari
- Department of Neurosurgery, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Hiroya Hara
- Department of Clinical Laboratory, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Ken Johkura
- Department of Neurology, Yokohama Brain and Spine Center, Yokohama, Japan.
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Cognitive Functions after Carotid Artery Stenting-1-Year Follow-Up Study. J Clin Med 2022; 11:jcm11113019. [PMID: 35683407 PMCID: PMC9180931 DOI: 10.3390/jcm11113019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/29/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The revascularization of carotid arteries minimizes the risk of future cerebral stroke and usually improves cognitive functions. The aim of this study was to assess changes in cognitive function and verify the hypothesis assuming an improvement of selected cognitive functions—psychomotor speed, visuospatial episodic memory, executive function and verbal fluency—in patients after carotid artery stenting during a 12-month follow-up. Methods: 47 persons subject to CAS, including 13 symptomatic persons, were examined before and 12 months after a procedure with a psychological test battery (digit symbol test—DS, Rey–Osterrieth complex figure test—ROCF, Wisconsin Card Sorting Test—WCST, letter verbal fluency—LVF). Sociodemographic data and clinical parameters were acquired from an author questionnaire. Results: The one-year follow-up, after the performed CAS procedure, demonstrated a significant improvement of psychomotor speed, visuospatial episodic memory, and executive function. No changes in the area of verbal fluency or decline in any of cognitive functions under analysis were observed. Conclusions: Carotid artery stenting improves cognitive functioning, both in the area of basic and more complex cognitive functions in persons with carotid atherosclerosis.
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Piegza M, Więckiewicz G, Wierzba D, Piegza J. Cognitive Functions in Patients after Carotid Artery Revascularization-A Narrative Review. Brain Sci 2021; 11:brainsci11101307. [PMID: 34679372 PMCID: PMC8533732 DOI: 10.3390/brainsci11101307] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/12/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022] Open
Abstract
Carotid revascularization may lead to improved cognitive function beyond stroke prevention. This article summarizes the conclusions from available studies on the effects of carotid reperfusion procedures on cognitive function. The papers cited used different neuropsychological tests for cognitive assessment, resulting in different methodologies and the results obtained were not always convergent. However, most studies reported an improvement in neurocognitive abilities after both vascular interventions, but a more precise assessment of the specific benefits is still awaited. Clinical determinants to predict the effects of these treatments on cognitive function are still being sought, but results are not yet satisfactory. In view of these studies, carotid stenosis seems to be an independent risk factor for cognitive deterioration, and the main mechanisms responsible are embolism and cerebral hypoperfusion. The aim of this study is to order the knowledge about the effects of carotid artery stenting (CAS) and endarterectomy (CEA) on neurocognitive functions and to verify the usefulness of using these treatments.
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Affiliation(s)
- Magdalena Piegza
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 42-612 Tarnowskie Góry, Poland;
| | - Gniewko Więckiewicz
- Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 42-612 Tarnowskie Góry, Poland;
- Correspondence:
| | - Dawid Wierzba
- Independent Public Heath Care Psychiatric Hospital, 44-180 Toszek, Poland;
| | - Jacek Piegza
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Zabrze, Poland;
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Matsumoto T, Hoshi H, Hirata Y, Ichikawa S, Fukasawa K, Gonda T, Poza J, Rodríguez-González V, Gómez C, Shigihara Y. The association between carotid blood flow and resting-state brain activity in patients with cerebrovascular diseases. Sci Rep 2021; 11:15225. [PMID: 34315975 PMCID: PMC8316461 DOI: 10.1038/s41598-021-94717-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/15/2021] [Indexed: 11/09/2022] Open
Abstract
Cerebral hypoperfusion impairs brain activity and leads to cognitive impairment. Left and right common carotid arteries (CCA) are the major source of cerebral blood supply. It remains unclear whether blood flow in both CCA contributes equally to brain activity. Here, CCA blood flow was evaluated using ultrasonography in 23 patients with cerebrovascular diseases. Resting-state brain activity and cognitive status were also assessed using magnetoencephalography and a cognitive subscale of the Functional Independence Measure, respectively, to explore the relationships between blood flow, functional brain activity, and cognitive status. Our findings indicated that there was an association between blood flow and resting-state brain activity, and between resting-state brain activity and cognitive status. However, blood flow was not significantly associated with cognitive status directly. Furthermore, blood velocity in the right CCA correlated with resting-state brain activity, but not with the resistance index. In contrast, the resistance index in the left CCA correlated with resting-state brain activity, but not with blood velocity. Our findings suggest that hypoperfusion is important in the right CCA, whereas cerebral microcirculation is important in the left CCA for brain activity. Hence, this asymmetry should be considered when designing appropriate therapeutic strategies.
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Affiliation(s)
- Takahiro Matsumoto
- Department of Neurosurgery, Kumagaya General Hospital, Kumagaya, 360-8567, Japan
| | - Hideyuki Hoshi
- Precision Medicine Centre, Hokuto Hospital, Kisen-7-5 Inadacho, Obihiro, Hokkaido, 080-0833, Japan
| | - Yoko Hirata
- Department of Neurosurgery, Kumagaya General Hospital, Kumagaya, 360-8567, Japan
| | - Sayuri Ichikawa
- Clinical Laboratory, Kumagaya General Hospital, Kumagaya, 360-8567, Japan
| | - Keisuke Fukasawa
- Clinical Laboratory, Kumagaya General Hospital, Kumagaya, 360-8567, Japan
| | - Tomoyuki Gonda
- Department of Rehabilitation, Kumagaya General Hospital, Kumagaya, 360-8567, Japan
| | - Jesús Poza
- Biomedical Engineering Group, Higher Technical School of Telecommunications Engineering, University of Valladolid, Castilla y León, 47011, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, (CIBER-BBN), Biomateriales y Nanomedicina, Castilla y León, 47011, Valladolid, Spain.,Instituto de Investigación en Matemáticas (IMUVA), University of Valladolid, Castilla y León, 47011, Valladolid, Spain
| | - Víctor Rodríguez-González
- Biomedical Engineering Group, Higher Technical School of Telecommunications Engineering, University of Valladolid, Castilla y León, 47011, Valladolid, Spain
| | - Carlos Gómez
- Biomedical Engineering Group, Higher Technical School of Telecommunications Engineering, University of Valladolid, Castilla y León, 47011, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, (CIBER-BBN), Biomateriales y Nanomedicina, Castilla y León, 47011, Valladolid, Spain
| | - Yoshihito Shigihara
- Precision Medicine Centre, Hokuto Hospital, Kisen-7-5 Inadacho, Obihiro, Hokkaido, 080-0833, Japan. .,Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, 360-8567, Japan.
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Turowicz A, Czapiga A, Malinowski M, Majcherek J, Litarski A, Janczak D. Carotid Revascularization Improves Cognition in Patients With Asymptomatic Carotid Artery Stenosis and Cognitive Decline. Greater Improvement in Younger Patients With More Disordered Neuropsychological Performance. J Stroke Cerebrovasc Dis 2021; 30:105608. [PMID: 33461024 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105608] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/24/2020] [Accepted: 01/02/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES There has been a growing interest in whether carotid revascularization may reverse cognitive decline. In this study the aim was to assess cognitive changes after carotid artery endarterectomy and stenting, using neuropsychological assessment with MoCA and CANTAB test. MATERIALS AND METHODS Seventy patients with asymptomatic carotid artery stenosis, qualified for CEA (study group A) and CAS (study group B) have been prospectively assessed. 20 patients with lower extremity artery disease (control group C) and 15 patients qualified for inguinal hernia surgery (control group D) have served as a control group. Patients have been evaluated 1 day before surgery and 6 months after, using MoCA and CANTAB test. Logistic regression models were built to determine variables affecting cognitive performance. RESULTS After the procedure in the study group A the cognitive evaluation showed improvement in 5 cognitive domains tested in MoCA: visuospatial/executive (p=.0496), naming (p=.0831), language (p=.0009), abstraction (p=.0126) and delayed recall (p=.0016). In CANTAB there were improvement in PAL (p=.0290) and SWM (p=.0105). In study group B positive cognitive changes were seen in visuospatial/executive (p=.0827) and delayed recall (p=.0041) tested with MoCA and in PAL (PALFAMS28 p=.0315, PALNPR28 p=.0090, PALTEA28 p=.0058) and SWM (p=.0882) tested with CANTAB. Using a regression model, the only strong predictors of cognitive improvement on the follow-up visit were younger age and lower MoCA score on the first visit. CONCLUSIONS Carotid revascularization, both open and endovascular, lead to cognitive improvement in patients with severe carotid stenosis and cognitive decline. This effect seems to be stronger in younger patients with worst cognitive performance before surgery.
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Affiliation(s)
- Agnieszka Turowicz
- Department of Vascular Surgery, 4th Military Teaching Hospital, 5 Weilga street, 50-981 Wrocław, Poland; Department of Vascular, General and Transplant Surgery, Faculty of Medicine, Wrocław Medical University, 213 Borowska street, 50-556 Wrocław, Poland.
| | - Alina Czapiga
- Institute of Psychology, University of Wroclaw, 1 Dawida street, 50-529 Wrocław, Poland.
| | - Maciej Malinowski
- Department of Vascular, General and Transplant Surgery, Faculty of Medicine, Wrocław Medical University, 213 Borowska street, 50-556 Wrocław, Poland.
| | - Jarosław Majcherek
- Department of Vascular Surgery, 4th Military Teaching Hospital, 5 Weilga street, 50-981 Wrocław, Poland.
| | - Andrzej Litarski
- Department of Vascular Surgery, 4th Military Teaching Hospital, 5 Weilga street, 50-981 Wrocław, Poland.
| | - Dariusz Janczak
- Department of Vascular, General and Transplant Surgery, Faculty of Medicine, Wrocław Medical University, 213 Borowska street, 50-556 Wrocław, Poland.
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