Gardener Hannah, Caunca Michelle R, Dong Chuanhui, Cheung Ying Kuen, Elkind Mitchell S V, Sacco Ralph L, Rundek Tatjana, Wright Clinton B
From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.).
Stroke. 2017 Jul;48(7):1855-1861. doi: 10.1161/STROKEAHA.117.016921. Epub 2017 Jun 19.
Ultrasound markers of carotid atherosclerosis may be related to cognitive status. We hypothesized that individuals with greater carotid intima-media thickness (cIMT) and carotid plaque burden would exhibit worse cognition.
One thousand one hundred sixty-six stroke-free participants from the NOMAS (Northern Manhattan Study) underwent carotid ultrasound and neuropsychological examination. Among them, 826 underwent a second neuropsychological examination an average of 5 years later. cIMT and plaque were assessed by a standardized B-mode ultrasound imaging and reading protocol. We used multivariable linear regression to examine cIMT, carotid plaque presence, and carotid plaque area as correlates of domain-specific neuropsychological scores cross-sectionally and over time. We also investigated possible effect modification by allele, age, and race/ethnicity.
Participants had a mean (SD) age of 70 (9) years and were 60% women, 66% Hispanic, 15% white, and 18% black. Those with greater cIMT exhibited worse episodic memory after adjustment for demographics and vascular risk factors (β=-0.60; =0.04). carriers with greater cIMT exhibited worse episodic memory (β=-1.31; =0.04), semantic memory (β=-1.45; =0.01), and processing speed (β=-1.21; =0.03). Participants with greater cIMT at baseline did not exhibit significantly greater cognitive decline after adjustment. noncarriers with greater cIMT exhibited greater declines in executive function (β=-0.98; =0.06). Carotid plaque burden was not significantly associated with cognition at baseline or over time.
Subclinical carotid atherosclerosis was associated with worse cognition among those at higher risk for Alzheimer disease. Interventions targeting early stages of atherosclerosis may modify cognitive aging.
颈动脉粥样硬化的超声标志物可能与认知状态有关。我们推测，颈动脉内膜中层厚度（cIMT）更大且颈动脉斑块负荷更高的个体认知功能会更差。
来自北曼哈顿研究（NOMAS）的1166名无中风参与者接受了颈动脉超声检查和神经心理学检查。其中，826人在平均5年后接受了第二次神经心理学检查。通过标准化的B型超声成像和解读方案评估cIMT和斑块情况。我们使用多变量线性回归，从横断面和随时间变化两个方面，研究cIMT、颈动脉斑块存在情况以及颈动脉斑块面积与特定领域神经心理学评分之间的相关性。我们还研究了等位基因、年龄和种族/民族可能产生的效应修正作用。
参与者的平均（标准差）年龄为70（9）岁，女性占60%，西班牙裔占66%，白人占15%，黑人占18%。在对人口统计学和血管危险因素进行调整后，cIMT更大的个体表现出更差的情景记忆（β=-0.60；P=0.04）。携带特定等位基因且cIMT更大的个体表现出更差的情景记忆（β=-1.31；P=0.04）、语义记忆（β=-1.45；P=0.01）和处理速度（β=-1.21；P=0.03）。基线时cIMT更大的参与者在调整后并未表现出明显更大的认知衰退。未携带特定等位基因且cIMT更大的个体在执行功能方面表现出更大的衰退（β=-0.9 ;P=0.06）。颈动脉斑块负荷在基线时或随时间变化与认知功能均无显著关联。
在患阿尔茨海默病风险较高的人群中，亚临床颈动脉粥样硬化与较差的认知功能有关。针对动脉粥样硬化早期阶段的干预措施可能会改变认知衰老。
