University Neurology Department, University Hospital Center Sestre milosrdnice, Vinogradska 29, Zagreb, Croatia.
J Neurol Sci. 2012 Nov 15;322(1-2):107-11. doi: 10.1016/j.jns.2012.07.008. Epub 2012 Aug 25.
The term neurologic symptom usually relates to the loss of motor or sensory functions; cognitive deficit is mostly unrecognized in patients with severe carotid stenosis. In large population studies carotid stenosis has been shown as independent risk factor for mild cognitive impairment (MCI) and it was not due to underlying vascular risk factors. The term MCI refers to a transitional stage between cognitive changes of normal aging and vascular dementia. At this stage, cognitive decline is not severe enough to constitute dementia, but also it is beyond the cognitive functioning deficit which is expected in normal aging. Carotid stenosis detected in population older than 65 is 75% for men and 62% for women, with prevalence of stenosis ≥ 50% in this population 7% for men and 5% for women. There are two possible underlying pathomorphological mechanisms of cognitive changes in patients with carotid disease - cerebral emboli and hypoperfusion with or without silent brain infarctions. In both cases loss of regional cerebral autoregulation can be recognized by means of neurosonology (transcranial Doppler ultrasonography). Most of the studies which evaluated cognitive functions before and after CEA/CAS have shown improvement or no changes in cognitive functions, but no deteriorations. There are still no clear recommendations about using CEA/CAS in treating cognitive deficit in otherwise asymptomatic patients. It is important to recognize cognitive changes as a symptom of carotid disease in order to follow up such patients and include cognitive deficit as one of the criteria in calculating perioperative risk and benefit from CEA/CAS.
神经症状一词通常与运动或感觉功能的丧失有关；认知缺陷在严重颈动脉狭窄的患者中大多未被识别。在大型人群研究中，颈动脉狭窄已被证明是轻度认知障碍（MCI）的独立危险因素，而且不是由于潜在的血管危险因素。MCI 一词是指认知正常老化和血管性痴呆之间的过渡阶段。在这个阶段，认知下降还没有严重到足以构成痴呆，但也超出了正常老化所预期的认知功能缺陷。在 65 岁以上的人群中检测到的颈动脉狭窄，男性为 75%，女性为 62%，该人群中狭窄程度≥50%的患病率为男性 7%，女性 5%。颈动脉疾病患者认知变化的两种可能的潜在病理形态学机制是脑栓塞和低灌注伴或不伴无症状性脑梗死。在这两种情况下，都可以通过神经超声（经颅多普勒超声）识别区域性脑自动调节的丧失。大多数评估颈动脉内膜切除术（CEA）/颈动脉内膜切除术（CAS）前后认知功能的研究表明，认知功能有所改善或无变化，但没有恶化。对于无症状患者，目前仍没有明确的关于使用 CEA/CAS 治疗认知缺陷的建议。重要的是要认识到认知变化是颈动脉疾病的一个症状，以便对这些患者进行随访，并将认知缺陷纳入计算围手术期风险和 CEA/CAS 获益的标准之一。
