Cognitive Impairment and Decline Are Associated with Carotid Artery Disease in Patients without Clinically Evident Cerebrovascular Disease

S. Claiborne Johnston, Ellen S. O'Meara, Teri A. Manolio, David Lefkowitz, Daniel H. O'Leary, Steven Goldstein, Michelle C. Carlson, Linda P. Fried, W. T. Longstreth

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Whether carotid artery disease is a cause of cognitive impairment in persons who have not had stroke is unknown. If this is the case, diminished performance on the Modified Mini-Mental State Examination should be more common in persons with left carotid artery disease than in those with right carotid artery disease. Objective: To determine whether left carotid artery disease is associated with cognitive impairment. Design: Cross-sectional and cohort study. Setting: Four U.S. communities participating in the Cardiovascular Health Study. Patients: 4006 right-handed men and women 65 years of age or older without history of stroke, transient ischemic attack, or carotid endarterectomy. Measurements: internal carotid artery stenosis and intima-media thickness of the common carotid artery were assessed by using duplex ultrasonography. Cognitive impairment was defined as a score less than 80 on the Modified Mini-Mental State Examination, and cognitive decline was defined as an average decrease of more than 1 point annually in Modified Mini-Mental State Examination score during up to 5 years of follow-up. Multivariate logistic regression models were used to estimate the risk for cognitive impairment and decline associated with left internal carotid artery stenosis and intima-media thickness, after adjustment for measures of right-sided disease and risk factors for vascular disease. Results: After adjustment for right-sided stenosis, high-grade (≥75% narrowing of diameter) stenosis of the left internal carotid artery (32 patients) was associated with cognitive impairment (odds ratio, 6.7 [95% CI, 2.4 to 18.1] compared with no stenosis) and cognitive decline (odds ratio, 2.6 [CI, 1.1 to 6.3]). Intima-media thickness of the left common carotid artery was associated with cognitive impairment and decline in univariate analysis, but this effect did not persist after adjustment. Conclusions: Cognitive impairment and decline are associated with asymptomatic high-grade stenosis of the left internal carotid artery. The persistence of the association after adjustment for right-sided stenosis indicates that the association is not due to underlying vascular risk factors or atherosclerosis in general.

Original languageEnglish (US)
Pages (from-to)237-247+I34
JournalAnnals of internal medicine
Volume140
Issue number4
DOIs
StatePublished - Feb 17 2004
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine

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