Department of Psychiatry and Clinical Psychobiology, Universitat de Barcelona, 08035 Barcelona, Spain; Institute for Brain, Cognition and Behavior (IR3C), Universitat de Barcelona, 08035 Barcelona, Spain.
Atherosclerosis. 2013 Oct;230(2):330-5. doi: 10.1016/j.atherosclerosis.2013.08.011. Epub 2013 Aug 17.
Carotid atherosclerosis has emerged as a relevant contributor to cognitive impairment and dementia whereas the role of intracranial stenosis and vascular resistance in cognition remains unknown. This study aims to assess the association of asymptomatic cervicocerebral atherosclerosis and intracranial vascular resistance with cognitive performance in a large dementia-free population.
The Barcelona-AsIA (Asymptomatic Intracranial Atherosclerosis) Neuropsychology Study included 747 Caucasian subjects older than 50 with a moderate-high vascular risk (assessed by REGICOR score) and without history of neither symptomatic vascular disease nor dementia. Extracranial and transcranial color-coded duplex ultrasound examination was performed to assess carotid intima-media thickness (IMT), presence of carotid plaques (ECAD group), intracranial stenosis (ICAD group), and middle cerebral artery pulsatility index (MCA-PI) as a measure of intracranial vascular resistance. Neuropsychological assessment included tests in three cognitive domains: visuospatial skills and speed, verbal memory and verbal fluency.
In univariate analyses, carotid IMT, ECAD and MCA-PI were associated with lower performance in almost all cognitive domains, and ICAD was associated with poor performance in some visuospatial and verbal cognitive tests. After adjustment for age, sex, vascular risk score, years of education and depressive symptoms, ECAD remained associated with poor performance in the three cognitive domains and elevated MCA-PI with worse performance in visuospatial skills and speed.
Carotid plaques and increased intracranial vascular resistance are independently associated with low cognitive functioning in Caucasian stroke and dementia-free subjects. We failed to find an independent association of intracranial large vessel stenosis with cognitive performance.
颈动脉粥样硬化已成为认知障碍和痴呆的一个重要致病因素，而颅内狭窄和血管阻力在认知中的作用尚不清楚。本研究旨在评估无痴呆症状的颈颅动脉粥样硬化和颅内血管阻力与认知表现之间的相关性。
巴塞罗那-AsIA（无症状颅内动脉粥样硬化）神经心理学研究纳入了 747 名年龄大于 50 岁的白种人，他们的血管风险中等偏高（由 REGICOR 评分评估），且既无症状性血管疾病也无痴呆病史。进行颅外和经颅彩色编码双功超声检查以评估颈动脉内膜中层厚度（IMT）、颈动脉斑块（ECAD 组）、颅内狭窄（ICAD 组）和大脑中动脉搏动指数（MCA-PI），作为颅内血管阻力的指标。神经心理学评估包括三个认知领域的测试：视觉空间技能和速度、言语记忆和言语流畅性。
在单变量分析中，颈动脉 IMT、ECAD 和 MCA-PI 与几乎所有认知领域的表现较差相关，而 ICAD 与某些视觉空间和言语认知测试的表现较差相关。在校正年龄、性别、血管风险评分、受教育年限和抑郁症状后，ECAD 仍与三个认知领域的表现较差相关，而升高的 MCA-PI 与视觉空间技能和速度的表现较差相关。
颈动脉斑块和颅内血管阻力增加与白种人无卒中和痴呆的认知功能低下独立相关。我们未能发现颅内大血管狭窄与认知表现之间存在独立的相关性。
