| Background and ObjectivesThe relationship between carotid artery stenosis and cognitive dysfunction has been a hot topic in the area of cerebrovascular disease.Current studies have demonstrated that patients with carotid artery stenosis have impaired cognitive function while the underlying mechanism remains unclear.The clinical practice has suggested that the effect of different recanalization therapies,like carotid artery stenting(CAS)and carotid endarterectomy(CEA)on cognitive function was inconsistent.Hence,it was necessary to determine the effect of carotid artery stenosis on cognitive function in the long-term follow-up.On the meanwhile,cerebral small vessel disease(CSVD)is related to cognitive function and many patients with carotid artery stenosis have leukoaraiosis.And the patients with leukoaraiosis have more severe cognitive function compared who without leukoaraiosis.Hence,our present study aimed to investigate the relationship among carotid stenosis,cerebral small vessel disease and vascular cognitive impairment,which may provide novel insight into vascular cognitive impairment.MethodsStroke patients were screened from Soochow stroke registry system and a total of 431 cases,including 236 patients without leukoaraiosis and 195 cases of LA were involved in the present study.Leukoaraiosis,the carotid artery stenosis,hypertension,high cholesterol,age and so on were analyzed as risk factors.The patients with moderate or severe carotid artery stenosis of 241 cases were divided into LA and non-LA group.The rate of unstable plaque was compared between the two groups.The cognitive function of patients with carotid artery stenosis was assessed.Among the patients,there were 83 non-LA patients and 93 LA patients.The cognitive function was assessed using the Alzheimer’s disease assessment scale-cognitive sub scale(ADAS-Cog),Clinical Dementia Rating Scale(CDR),activities of daily living scale(ADL),mini-mental state examination(MMSE),The Montreal cognitive assessment scale(MoCA),converting Wechsler Digit Symbol test,digit span tests and language fluency test.The patients undergoing carotid artery stenting(CAS)were analyzed before CAS and 1,3,6 and 12 months after surgery using MRI.ResultsThe results showed that carotid stenosis,hypertension and high cholesterol was an independent risk for leukoaraiosis,which suggested Leukoaraiosis was closely associated with cerebral vascular stenosis.The degree of carotid artery stenosis and characterizes of carotid atherosclerotic plaques had a strong correlation with LA scores.LA group had a higher rate incidence of unstable plagues comparing to no-LA group.Property of plagues could indicate occurrence,progress and severity of LA.Patients with carotid artery stenosis had much more severe cognitive dysfunction in LA group when compared to non-LA group.For patients with carotid artery stenosis,CAS alleviated the LA scores and improved the cognitive function.ConclusionsOur study showed that LA was closely associated with carotid artery stenosis.Carotid artery stenosis was an independent risk factor to LA.CAS could alleviate degree of lesion and improve cognitive function in patients with LA. |
