Chronic Ischemia and Neurocognition
Section snippets
Evidence of impaired cognition due to carotid artery disease
Cognitive impairment has been reported in a wide spectrum of clinical studies in patients who have carotid disease, most frequently in global terms rather than as a specific, neurocognitive profile. Fischer [1], [2] was the first to postulate an association between cerebral hypoperfusion and dementia, based on a necropsy study of a demented patient who had bilateral carotid occlusion. A few years later, Carey and colleagues [3] reported dementia in four patients who had bilateral carotid
Hypoperfusion
The refinement of new imaging techniques that measure cerebral hemodynamics directly has advanced our understanding of the relationship between hypoperfusion in carotid diseases and cognitive impairment. Tatemichi and colleagues [25] documented the case of a 55-year-old man with bilateral internal carotid and unilateral vertebral artery occlusions presenting with a subacute onset of severe behavioral and cognitive changes. Quantitative cerebral blood flow (CBF) and positron emission tomography
Chronic ischemia and neuronal impairment
If hypoperfusion is the primary model for the link between carotid disease and cognitive impairment, one must provide evidence that
Chronic ischemia exists and results in neuronal dysfunction.
Chronic ischemia and neuronal dysfunction are reversible.
Chronic ischemia and reversibility correlate with functional behavioral measures.
Animal studies can provide a pure model of chronic cerebral hypoperfusion. Ohta and colleagues [118] investigated the effect of chronic cerebral ischemia on learning
Summary
Substantial evidence indicates that chronic ischemia is a progressive, dynamic process that may manifest with cognitive dysfunction as the ischemic conditions persist, with functional deficits becoming evident and additional neuronal infarction prevailing if chronic ischemia is not reversed. By incorporating the pathophysiology of chronic ischemia into the algorithm of the management of carotid artery disease, we may be able to extend the goals of carotid artery revascularization beyond merely
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Cited by (25)
The neuron-astrocyte-microglia triad in CA3 after chronic cerebral hypoperfusion in the rat: Protective effect of dipyridamole
2017, Experimental GerontologyCitation Excerpt :In our study, dipyridamole was tested in the 2VO model to evaluate its protective role against the physiopathological mechanisms that the ischemic insult exerts in the CA3 region of the hippocampus. Brain chronic hypoperfusion, caused by partial carotid occlusion during aging, represents a chronic, dynamic process that causes multiple progressive alterations, and eventually leads to neurodegeneration (Ozacmak et al. 2007; Farkas et al. 2007) and vascular dementia (Chmayssani et al. 2007). The CA1 region of the hippocampus results particularly vulnerable to decreased blood flow and glucose supply caused by 2VO occlusion, that cause failure of neuronal signaling, and impairments in hippocampally-based forms of memory (De Jong et al. 1999; Liu et al. 2005; Farkas et al. 2006; Melani et al. 2010; Lana et al. 2013).
Asymptomatic carotid stenosis and cognitive improvement using transcervical stenting with protective flow reversal technique
2014, European Journal of Vascular and Endovascular SurgeryCitation Excerpt :This explains why neuropsychological evaluation could be a sensitive outcome measure in primary or secondary prevention. In keeping with the findings from previous studies,23,24 these results indicate that cognitive function in patients with asymptomatic carotid stenosis is below the established parameters of normality. Overall cognitive performance was affected (32.0%), and particularly information processing (62.5%), executive function (12.0%), and memory (56.0%).
ADC mapping of chronic cerebral hypoperfusion induced by carotid artery stenosis
2011, Journal of NeuroradiologyCitation Excerpt :Carotid stenosis may induce a chronic hypoperfusion. To assess changes in brain perfusion in carotid disease, a number of techniques have been used such as parenchymography [4] and CT perfusion [5]. Diffusion-weighted MR is a technique that images the molecular motion of tissue [6,7], which allows for the acquisition of a measure of fractional anisotropy [8].
Vascular Cognitive Impairment
2010, Brocklehurst's Textbook of Geriatric Medicine and GerontologyOne-year Cognitive Outcomes Associated with Carotid Artery Stent Placement
2010, Journal of Vascular and Interventional RadiologyCarotid Artery Ultrasound and Echocardiography Testing to Lower the Prevalence of Alzheimer's Disease
2009, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :A strong correlation between AD and VaD that can develop later in life and increased IMT of the carotid arteries resulting from progressive atherosclerosis was first reported in the Rotterdam Study more than a decade ago.75 This finding was confirmed in a larger, population-based prospective cohort study with a mean follow-up of 9 years that included nearly 8000 elderly persons,76 and in other independent studies.77-81 The degree of carotid artery narrowing appears to correlate with the extent of cognitive loss.
This article was supported by NIH grant R01 NS048212-01A1 and the Richard and Jenny Levine Research Fund.