Abstract
While stroke is a known cause of a cognitive impairment, the relationship between
a carotid artery stenosis and the cognitive function in individuals without a history
of stroke is less clear. A number of risk factors for vascular disease are related
to a cognitive impairment. Hypertension, diabetes mellitus, cigarette smoking, and
dyslipidemia are also associated with an increased risk of carotid artery disease.
Some studies have suggested that a stenosis of the internal carotid artery may be
an independent risk factor for a cognitive impairment. A high-grade stenosis of the
internal carotid artery may be associated with a cognitive impairment even without
evidence of infarction on magnetic resonance imaging. On the other hand, it is fairly
common that patients display a normal cognition despite severe carotid artery disease,
highlighting the important role of an efficient collateral blood supply. The possible
pathomechanisms of a cognitive impairment include silent embolization and hypoperfusion.
Carotid endarterectomy or stenting may lead to a decline in the cognitive function
in consequence of microembolic ischemia or intraprocedural hypoperfusion. Conversely,
perfusion restoration could improve a cognitive dysfunction that might have occurred
from a state of chronic hypoperfusion. It is unclear whether these complex interactions
ultimately result in a net improvement or a deterioration of the cognitive function.
The evidence available at present does not seem strong enough to include consideration
of a loss of cognition as a factor in determining the balance of the risks and benefits
of therapy for a carotid stenosis.
Keywords
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Article info
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Published online: March 09, 2009
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© 2009 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
