Hattori Yorito, Kakino Yoshinori, Nakaoku Yuriko, Ogata Soshiro, Yoshimoto Takeshi, Nishimura Kunihiro, Iida Hidehiro, Ihara Masafumi
Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Preemptive Medicine for Dementia, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
J Alzheimers Dis. 2025 Jul;106(2):589-604. doi: 10.1177/13872877251344259. Epub 2025 Jul 1.
BackgroundThe severity of cerebral hemodynamic impairment in patients with carotid artery stenosis or occlusion (CASO) is not always correlated with the severity of stenosis or occlusion. There are no established noninvasive indicators of cerebral hemodynamic impairment in CASO.ObjectiveThe study aimed to identify impaired neurocognitive domains as promising noninvasive severity markers.MethodsIn a retrospective study of 142 patients with asymptomatic CASO, we assessed associations of Montreal Cognitive Assessment (MoCA) and Alzheimer's Disease Assessment Scale-Cognitive Subscale 14 (ADAS-Cog) with O-gas positron emission tomography.ResultsIn patients with right CASO (n = 45), worse delayed recall on MoCA was significantly associated with decreased CBF (adjusted β for cerebral blood flow [CBF] 1.70, 95% confidence interval [CI] 0.21-3.28, = 0.027), with the cutoff value of 1/2 for CBF of <35.0 mL/100 g/min (sensitivity 100%). In patients with left CASO (n = 60), language comprehension on ADAS-Cog was significantly associated with increased OEF (adjusted β for oxygen extraction fraction 5.48, 95% CI 2.29-8.67, = 0.001), with the cutoff value of 0/1 for OEF of >52.9% (specificity 96.4%). In patients with bilateral CASO (n = 37), worse executive function on MoCA score was significantly associated with decreased CBF (adjusted β for CBF 2.70, 95% CI 0.29-5.13, = 0.030), with the cutoff value of 2/3 for CBF of <35.0 mL/100 g/min (sensitivity 83.3%).ConclusionsNeuropsychological examinations could be useful for noninvasively estimating the severity of cerebral hemodynamic impairment in patients with CASO.
背景
颈动脉狭窄或闭塞（CASO）患者脑血流动力学损害的严重程度并不总是与狭窄或闭塞的严重程度相关。目前尚无公认的CASO脑血流动力学损害的非侵入性指标。
目的
本研究旨在确定受损的神经认知领域作为有前景的非侵入性严重程度标志物。
方法
在一项对142例无症状CASO患者的回顾性研究中，我们评估了蒙特利尔认知评估量表（MoCA）和阿尔茨海默病评估量表认知分量表14（ADAS-Cog）与氧气体正电子发射断层扫描的相关性。
结果
在右侧CASO患者（n = 45）中，MoCA延迟回忆能力较差与脑血流量（CBF）降低显著相关（脑血流量调整β值为1.70，95%置信区间[CI]为0.21 - 3.28，P = 0.027），CBF<35.0 mL/100 g/min时的截断值为1/2（敏感性为100%）。在左侧CASO患者（n = 60）中，ADAS-Cog语言理解能力与氧摄取分数（OEF）升高显著相关（氧摄取分数调整β值为5.48，95%CI为2.29 - 8.67，P = 0.001），OEF>52.9%时的截断值为0/1（特异性为96.4%）。在双侧CASO患者（n = 37）中，MoCA评分中执行功能较差与CBF降低显著相关（CBF调整β值为2.70，95%CI为0.29 - 5.13，P = 0.030），CBF<35.0 mL/100 g/min时的截断值为2/3（敏感性为83.3%）。
结论
神经心理学检查有助于非侵入性评估CASO患者脑血流动力学损害的严重程度。
