The role of carotid stenosis in vascular cognitive impairment was reviewed using Medline, EMBASE, PsychLit and PsychInfo databases using the words "carotid stenosis", "neuropsychological tests" and "endarterectomy". Limited evidence exists for frontal lobe dysfunction associated with carotid stenosis, but there is a lack of systematic and prospective studies carried out in consecutive patients, including appropriate neuropsychological and MRI assessment. Possible pathophysiological processes suggested for cognitive impairment associated with carotid stenosis are suggested; these include chronic ischaemia and lacunar infarction; such mechanisms and resultant pathologies may co-exist in the presence of large-artery atheroma.
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