Johnston S Claiborne, O'Meara Ellen S, Manolio Teri A, Lefkowitz David, O'Leary Daniel H, Goldstein Steven, Carlson Michelle C, Fried Linda P, Longstreth W T
Department of Neurology, University of California, San Francisco, San Francisco, California 94143-0114, USA.
Ann Intern Med. 2004 Feb 17;140(4):237-47. doi: 10.7326/0003-4819-140-4-200402170-00005.
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.
To determine whether left carotid artery disease is associated with cognitive impairment.
Cross-sectional and cohort study.
Four U.S. communities participating in the Cardiovascular Health Study.
4006 right-handed men and women 65 years of age or older without history of stroke, transient ischemic attack, or carotid endarterectomy.
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.
After adjustment for right-sided stenosis, high-grade (> or =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.
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.
颈动脉疾病是否为未发生过卒中者认知功能障碍的病因尚不清楚。如果是这样，那么在改良简易精神状态检查中表现不佳在左颈动脉疾病患者中应比右颈动脉疾病患者更常见。
确定左颈动脉疾病是否与认知功能障碍相关。
横断面研究和队列研究。
参与心血管健康研究的美国四个社区。
4006名65岁及以上的右利手男性和女性，无卒中、短暂性脑缺血发作或颈动脉内膜切除术史。
采用双功超声评估颈内动脉狭窄和颈总动脉内膜中层厚度。认知功能障碍定义为改良简易精神状态检查得分低于80分，认知功能减退定义为在长达5年的随访期间改良简易精神状态检查得分每年平均下降超过1分。在对右侧疾病指标和血管疾病危险因素进行校正后，使用多变量逻辑回归模型估计与左颈内动脉狭窄和内膜中层厚度相关的认知功能障碍和减退风险。
在校正右侧狭窄后，左颈内动脉高度（直径狭窄≥75%）狭窄（32例患者）与认知功能障碍（比值比为6.7[95%CI，2.4至18.1]，无狭窄者相比）和认知功能减退（比值比为2.6[CI，1.1至6.3]）相关。左颈总动脉内膜中层厚度在单变量分析中与认知功能障碍和减退相关，但校正后该效应未持续存在。
认知功能障碍和减退与左颈内动脉无症状性高度狭窄相关。在校正右侧狭窄后该关联仍然存在，表明该关联并非一般的潜在血管危险因素或动脉粥样硬化所致。
