scholarly journals Baseline Cognitive Impairment in Patients With Asymptomatic Carotid Stenosis in the CREST-2 Trial

2021 ◽  
Vol 74 (6) ◽  
pp. 2115-2116
Author(s):  
R.M. Lazar ◽  
V.G. Wadley ◽  
T. Myers ◽  
M.R. Jones ◽  
D.V. Heck ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Carotid Stenosis ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid

Cognitive Impairment Is Associated with Medication Nonadherence in Asymptomatic Carotid Stenosis

2014 ◽  
Vol 127 (12) ◽  
pp. 1243-1246 ◽  
Author(s):  
Angelia C. Kirkpatrick ◽  
Andrea S. Vincent ◽  
Leslie Guthery ◽  
Calin I. Prodan
Keyword(s):  
Cognitive Impairment ◽  
Carotid Stenosis ◽  
Asymptomatic Carotid Stenosis ◽  
Medication Nonadherence ◽  
Asymptomatic Carotid

Baseline Cognitive Impairment in Patients With Asymptomatic Carotid Stenosis in the CREST-2 Trial

Stroke ◽  
2021 ◽  
Author(s):  
Ronald M. Lazar ◽  
Virginia G. Wadley ◽  
Terina Myers ◽  
Michael R. Jones ◽  
Donald V. Heck ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Carotid Stenosis ◽  
Racial Differences ◽  
Carotid Artery Disease ◽  
Word List ◽  
Population Based ◽  
Asymptomatic Carotid Stenosis ◽  
Carotid Disease ◽  
Asymptomatic Carotid ◽  
List Learning

Background and Purpose: Studies of carotid artery disease have suggested that high-grade stenosis can affect cognition, even without stroke. The presence and degree of cognitive impairment in such patients have not been reported and compared with a demographically matched population-based cohort. Methods: We studied cognition in 1000 consecutive CREST-2 (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial) patients, a treatment trial for asymptomatic carotid disease. Cognitive assessment was after randomization but before assigned treatment. The cognitive battery was developed in the general population REGARDS Study (Reasons for Geographic and Racial Differences in Stroke), involving Word List Learning Sum, Word List Recall, and Word List fluency for animal names and the letter F. The carotid stenosis patients were >45 years old with ≥70% asymptomatic carotid stenosis and no history of prevalent stroke. The distribution of cognitive performance for the patients was standardized, accounting for age, race, and education using performance from REGARDS, and after further adjustment for hypertension, diabetes, dyslipidemia, and smoking. Using the Wald Test, we tabulated the proportion of Z scores less than the anticipated deviate for the population-based cohort for representative percentiles. Results: There were 786 baseline assessments. Mean age was 70 years, 58% men, and 52% right-sided stenosis. The overall Z score for patients was significantly below expected for higher percentiles ( P <0.0001 for 50th, 75th, and 95th percentiles) and marginally below expected for the 25th percentile ( P =0.015). Lower performance was attributed largely to Word List Recall ( P <0.0001 for all percentiles) and for Word List Learning (50th, 75th, and 95th percentiles below expected, P ≤0.01). The scores for left versus right carotid disease were similar. Conclusions: Baseline cognition of patients with severe carotid stenosis showed below normal cognition compared to the population-based cohort, controlling for demographic and cardiovascular risk factors. This cohort represents the largest group to date to demonstrate that poorer cognition, especially memory, in this disease. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02089217.

scholarly journals Thalamic Atrophy Plays a Crucial Role in the Effect of Asymptomatic Carotid Stenosis on Cognitive Impairment

2020 ◽  
Vol Volume 15 ◽  
pp. 2083-2094
Author(s):  
Wen Zhang ◽  
Zhao Qing ◽  
Yongwei Hu ◽  
Mingran Shao ◽  
Jiaming Lu ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Carotid Stenosis ◽  
Crucial Role ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid

scholarly journals Carotid revascularization and medical management for asymptomatic carotid stenosis – Hemodynamics (CREST-H): Study design and rationale

2018 ◽  
Vol 13 (9) ◽  
pp. 985-991 ◽  
Author(s):  
Randolph S Marshall ◽  
Ronald M Lazar ◽  
David S Liebeskind ◽  
E Sander Connolly ◽  
George Howard ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
White Matter ◽  
Carotid Stenosis ◽  
Medical Management ◽  
Cerebral Microbleeds ◽  
White Matter Hyperintensity ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Carotid Revascularization ◽  
One Year

Rationale For patients with asymptomatic high-grade carotid stenosis, clinical investigations have focused on preventing cerebral infarction, yet stenosis that reduces cerebral blood flow may independently impair cognition. Whether revascularization of a hemodynamically significant carotid stenosis can alter the course of cognitive decline has never been investigated in the context of a randomized clinical trial. Hypothesis Among patients randomized in the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis (CREST-2) trials, the magnitude of treatment differences (revascularization versus medical management alone) with regard to cognition will differ between those with flow impairment compared to those without flow impairment. Sample size We will enroll approximately 500 patients from CREST-2, of which we anticipate 100 will have hemodynamic impairment. We estimate 93% power to detect a clinically meaningful treatment difference of 0.5 SD. Methods and design We will use perfusion-weighted magnetic resonance imaging to stratify by hemodynamic status. Linear regression will compare treatment differences, controlling for baseline cognitive status, age, depression, prior cerebral infarcts, silent infarction, white matter hyperintensity volume, and cerebral microbleeds. Study outcomes The primary outcome is change in cognition at one year. Secondary outcomes include silent infarction, change in white matter hyperintensity volume, number of cerebral microbleeds, and cortical thickness over one year. Discussion If cognitive impairment can be shown to be reversible by revascularization, then we can redefine “symptomatic carotid stenosis” to include cognitive impairment and identify a new population of patients likely to benefit from revascularization. Trial Registration US National Institutes of Health (NIH) clinicaltrials.gov NCT03121209

scholarly journals Asymptomatic carotid stenosis is associated with cognitive impairment

2017 ◽  
Vol 66 (4) ◽  
pp. 1083-1092 ◽  
Author(s):  
Brajesh K. Lal ◽  
Moira C. Dux ◽  
Siddhartha Sikdar ◽  
Carly Goldstein ◽  
Amir A. Khan ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Carotid Stenosis ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid

Lack of association between cognitive impairment and systemic inflammation in asymptomatic carotid stenosis

2021 ◽  
Author(s):  
Sarasijhaa K. Desikan ◽  
Minerva Mayorga-Carlin ◽  
Moira C. Dux ◽  
Vicki L. Gray ◽  
John Anagnostakos ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Carotid Stenosis ◽  
Systemic Inflammation ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid
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