Relationship between Cognitive Function and Cerebrovascular Reactivity in Asymptomatic Carotid Stenosis Patients

doi:10.12114/j.issn.1007-9572.2018.00.020

Abstract

Abstract: Backgropund　The cognitive status of patients with asymptomatic carotid stenosis （ACS） is still unclear，and its relationship with cerebrovascular reactivity （CVR） is still unclear.Objective　To assess the relationship between cognitive function and CVR in ACS patients.Methods　The participants were enrolled from Weifang People's Hospital from October 2014 to September 2017，including 102 outpatients and inpatients with ACS（ACS group），and 26 healthy cases undergoing physical examination（control group）.We collected the general data in both groups.Transcranial Doppler ultrasound was used for breath-holding test （BHI）to assess CVR in patients with ACS.Based on the assessment results of CVR，ACS patients were divided into normal left CVR（LCVR）group（n=30），impaired LCVR group（n=23），normal right CVR（RCVR）group（n=28），impaired RCVR group（n=21）.Color Doppler ultrasound was used to assess carotid stenosis in ACS patients.The fourth edition of Wechsler Adult Intelligence Scale（WAIS-Ⅳ） was used to assess cognitive function in all participants.Results　There was significant difference in BHI among the 5 groups（P<0.05 ）.The degree of internal carotid artery stenosis did not differ significantly between the normal LCVR group，impaired LCVR group，normal RCVR group and impaired RCVR group（P>0.05）.The vocabulary score of the impaired LCVR group was lower than that of the other four groups（P<0.05）.The impaired RCVR group achieved lower scores of picture completion and visual puzzles compared with other four groups（P<0.05）.There was a positive correlation between the vocabulary score and BHI in the impaired LCVR group（r=0.713，P<0.05）.BHI was positively correlated with the picture completion score as well as the visual puzzles score in the impaired RCVR group（r=0.622，P<0.05；r=0.647，P<0.05）.Conclusion　In patients with ACS，there is a decrease in cognitive function among some patients with reduced CVR. The relevant cognitive domain is associated with the function of the ipsilateral hemisphere of the narrow carotid artery，and the degree of cognitive decline is related to the degree of CVR reduction.

Key words:
Carotid stenosis, Asymptomatic diseases, Cognition

摘要：

背景　无症状颈动脉狭窄（ACS）患者认知情况目前仍不清楚，且其与脑血管反应性（CVR）关系尚不明确。目的　评估ACS患者的认知功能及其与CVR的关系。方法　选取2014年10月—2017年9月于潍坊市人民医院就诊或住院的ACS患者102例，并同期选取本院健康体检者26例作为对照组。根据CVR受损侧别

及受损情况将ACS患者分为左侧CVR（LCVR）正常组30例，LCVR受损组23例，右侧CVR（RCVR）正常组28例，RCVR受损组21例。收集患者一般资料，采用经颅多普勒超声进行屏气指数（BHI）检测以评估ACS患者的CVR，彩色多普勒超声评估颈内动脉狭窄度，韦氏智力量表评估受试者认知功能。结果　5组BHI

比较，差异有统计学意义（P<0.05）；LCVR正常组、LCVR受损组、RCVR正常组、RCVR受损组颈内动脉狭窄度比较，差异均无统计学意义（P>0.05）。LCVR受损组词汇得分低于其余4组，RCVR受损组填图、图形拼凑得分低于其余4组（P<0.05）。LCVR受损组词汇得分与BHI呈正相关（r=0.713，P<0.05）；

RCVR受损组填图、图形拼凑得分与BHI呈正相关（r=0.622，P<0.05；r=0.647，P<0.05）。结论　ACS患者中CVR降低者存在部分认知功能下降，相关认知领域与狭窄颈动脉同侧半球的功能相关，且认知功能下降程度与CVR降低程度相关。

关键词: 颈动脉狭窄, 无症状疾病, 认知

SHI Baolin,ZHANG Shuyun,MIAO Yanxia, et al. Relationship between Cognitive Function and Cerebrovascular Reactivity in Asymptomatic Carotid Stenosis Patients[J]. Chinese General Practice, 2019, 22(6): 668-672. DOI: 10.12114/j.issn.1007-9572.2018.00.020.
时宝林,张淑云,苗艳霞等. 无症状颈动脉狭窄患者的认知功能及其与脑血管反应性的关系研究[J]. 中国全科医学, 2019, 22(6): 668-672. DOI: 10.12114/j.issn.1007-9572.2018.00.020.

References

［1］SPENCE J D.Management of asymptomatic carotid stenosis［J］．Neurol Clin，2015，33（2）：443-457．DOI：10.1016/j.ncl.2014.12.008.
［2］BALUCANI C，VITICCHI G，FALSETTI L，et al．Cerebral hemodynamics and cognitive performance in bilateral asymptomatic carotid stenosis［J］．Neurology，2012，79（17）：1788-1795．DOI：10.1212/WNL.0b013e318270402e.
［3］MARSHALL R S，FESTA J R，CHEUNG Y K，et al．Randomized Evaluation of Carotid Occlusion and Neurocognition （RECON） trial：main results［J］．Neurology，2014，82（9）：744-751．DOI：10.1212/WNL.0000000000000167.
［4］WAPP M，EVERTS R，BURREN Y，et al．Cognitive improvement in patients with carotid stenosis is independent of treatment type［J］．Swiss Med Wkly，2015，145：w14226．DOI：10.4414/smw.2015.14226.
［5］RICHIARDI J，MONSCH A U，HAAS T，et al．Altered cerebrovascular reactivity velocity in mild cognitive impairment and Alzheimer's disease［J］．Neurobiol Aging，2015，36（1）：33-41．DOI：10.1016/j.neurobiolaging.2014.07.020.
［6］SPENCE J D.Management of patients with an asymptomatic carotid stenosis——medical management，endovascular treatment，or carotid endarterectomy?［J］．Curr Neurol Neurosci Rep，2016，16
（1）：3．DOI：10.1007/s11910-015-0605-6.
［7］North American Symptomatic Carotid Endarterectomy Trial Collaborators，BARNETT H J M，TAYLOR D W，et al．Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis［J］．N Engl J Med，1991，325（7）：445-453．DOI：10.1056/NEJM199108153250701.
［8］CANIVEZ G L，WATKINS M W.Investigation of the factor structure of the Wechsler Adult Intelligence Scale——Fourth Edition （WAIS-Ⅳ）：exploratory and higher order factor analyses［J］．Psychol Assess，2010，22（4）：827-836．DOI：10.1037/a0020429.
［9］梁兴伦，朱敏洁，李琛，等．从胰岛素抵抗角度探讨化瘀解毒法治疗轻度认知功能障碍的临床疗效研究［J］．中国全科医学，2017，20（13）：1642-1647．DOI：10.3969/j.issn.1007-9572.2017.13.022.
LIANG X L，ZHU M J，LI C，et al．Clinical effect of dissolving blood stasis and detoxication on patients with mild cognitive impairment on the basis of insulin resistance［J］．Chinese General Practice，2017，20（13）：1642-1647．DOI：10.3969/j.issn.1007-9572.2017.13.022.
［10］NAKAMURA H，NAKANISHI M，FURUKAWA T A，et al．Validity of brief intelligence tests for patients with Alzheimer's disease［J］．Psychiatry Clin Neurosci，2000，54（4）：435-439．DOI：10.1046/j.1440-1819.2000.00733.x.
［11］MATSUDA O，SAITO M，KATO M，et al．Wechsler Adult Intelligence Scale-Ⅲprofile in the early stages of Alzheimer's disease：performance in subtests sensitive to and resistant to normal decline with ageing［J］．Psychogeriatrics，2015，15（1）：1-6．DOI：10.1111/psyg.12066.
［12］NELSON J M，CANIVEZ G L，WATKINS M W.Structural and incremental validity of the Wechsler Adult Intelligence Scale-Fourth Edition with a clinical sample［J］．Psychol Assess，2013，25（2）：618-630．DOI：10.1037/a0032086.
［13］LAL B K，DUX M C，SIKDAR S，et al．Asymptomatic carotid stenosis is associated with cognitive impairment［J］．J Vasc Surg，2017，66（4）：1083-1092．DOI：10.1016/j.jvs.2017.04.038.
［14］KIM H S，AN Y M，KWON J S，et al．A preliminary validity study of the cambridge neuropsychological test automated battery for the assessment of executive function in schizophrenia and bipolar disorder［J］．Psychiatry Investig，2014，11（4）：394-401．DOI：10.4306/pi.2014.11.4.394.
［15］SILVESTRINI M，PAOLINO I，VERNIERI F，et al．Cerebral hemodynamics and cognitive performance in patients with asymptomatic carotid stenosis［J］．Neurology，2009，72（12）：1062-1068．DOI：10.1212/01.wnl.0000345015.35520.52.
［16］BEISHON L，HAUNTON V J，PANERAI R B，et al．Cerebral hemodynamics in mild cognitive impairment：a systematic review［J］．J Alzheimers Dis，2017，59（1）：369-385．DOI：10.3233/JAD-170181.
［17］HOILAND R L，SMITH K J，CARTER H H，et al．Shear-mediated dilation of the internal carotid artery occurs independent of hypercapnia［J］．Am J Physiol Heart Circ Physiol，2017，313（1）：H24-31．DOI：10.1152/ajpheart.00119.2017.
［18］MITRASINOVIC A，KOLAR J，RADAK S，et al．Ultrasonografic monitoring of hemodynamic parameters in symptomatic and asymptomatic patients with high-grade carotid stenosis prior and following carotid endarterectomy［J］．Vojnosanit Pregl，2012，69（5）：399-404．DOI：10.2298/VSP1205399M.
［19］DUNCOMBE J，KITAMURA A，HASE Y，et al．Chronic cerebral hypoperfusion：a key mechanism leading to vascular cognitive impairment and dementia.Closing the translational gap between rodent models and human vascular cognitive impairment and dementia［J］．Clin Sci （Lond），2017，131（19）：2451-2468．DOI：10.1042/CS20160727.
［20］赵明磊，毕齐.无症状性颈动脉狭窄与认知功能障碍关系研究进展［J］．中国全科医学，2016，19（23）：2861-2865．DOI：10.3969/J.issn.1007-9572.2016.23.027.
ZHAO M L，BI Q.Research progress of the relationship between asymptomatic carotid stenosis and cognitive disorders［J］．Chinese General Practice，2016，19（23）：2861-2865．DOI：10.3969/J.issn.1007-9572.2016.23.027.
［21］BURATTI L，BALUCANI C，VITICCHI G，et al．Cognitive deterioration in bilateral asymptomatic severe carotid stenosis［J］．Stroke，2014，45（7）：2072-2077．DOI：10.1161/STROKEAHA.114.005645.
［22］DONAHUE M J，DETHRAGE L M，FARACO C C，et al．Routine clinical evaluation of cerebrovascular reserve capacity using carbogen in patients with intracranial stenosis［J］．Stroke，2014，45（8）：2335-2341．DOI：10.1161/STROKEAHA.114.005975.
［23］FEARN S J，HUTCHINSON S，RIDING G，et al．Carotid endarterectomy improves cognitive function in patients with exhausted cerebrovascular reserve［J］．Eur J Vasc Endovasc Surg，2003，26（5）：529-536．DOI：10.1016/S1078-5884（03）00384-8.
［24］GIUBILEI F，CIPOLLINI V，SETTE G，et al．Assessment of cerebral vasoreactivity using ultrasound techniques in Alzheimer's disease［J］．Alzheimer's & Dementia，2013，9（4）：P442．DOI：10.1016/j.jalz.2013.05.879.
［25］SILVESTRINI M，VITICCHI G，FALSETTI L，et al．The role of carotid atherosclerosis in Alzheimer's disease progression［J］．J Alzheimers Dis，2011，25（4）：719-726．DOI：10.3233/JAD-2011-101968.
［26］CHENG H L，LIN C J，SOONG B W，et al．Impairments in cognitive function and brain connectivity in severe asymptomatic carotid stenosis［J］．Stroke，2012，43（10）：2567-2573．DOI：10.1161/STROKEAHA.111.645614.
［27］张华，张淑平，王小新.无症状颈动脉狭窄患者认知功能障碍评估及其危险因素研究［J］.中国全科医学，2017，20（17）：2051-2056，2063.DOI：10.3969/j.issn.1007-9572.2017.17.003.
ZHANG H，ZHANG S P，WANG X X.Evaluation of cognitive impairment in patients with asymptomatic carotid stenosis and its risk factors［J］.Chinese General Practice，2017，20（17）：2051-2056，2063.DOI：10.3969/j.issn.1007-9572.2017.17.003.
［28］邱海鹏，张晓璇，朱云波，等.阿尔茨海默病患者血清中抗氧化物与认知损伤的相关性分析［J］.疑难病杂志，2016，15（3）：245-248.DOI：10.3969/j.issn.1671-6450.2016.03.007.
QIU H P，ZHANG X X，ZHU Y B，et al.The analysis on correlation between serum antioxidant and cognitive impairment in patients with Alzheimer's disease［J］.Chinese Journal of Difficult and Complicated Cases，2016，15（3）：245-248.DOI：10.3969/j.issn.1671-6450.2016.03.007.

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