scholarly journals Impact of carotid stenosis on cerebral hemodynamic failure and cognitive impairment progression: a narrative review

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Giovanna Viticchi ◽  
Lorenzo Falsetti ◽  
Eleonora Potente ◽  
Marco Bartolini ◽  
Mauro Silvestrini
Keyword(s):  
Cognitive Impairment ◽  
Carotid Stenosis ◽  
Narrative Review ◽  
Cerebral Hemodynamic ◽  
Hemodynamic Failure

scholarly journals Neurocognitive effects associated with proprotein convertase subtilisin-kexin type 9 inhibitor use: a narrative review

2021 ◽  
Vol 12 ◽  
pp. 204209862095927
Author(s):  
Wei C. Yuet ◽  
Didi Ebert ◽  
Michael Jann
Keyword(s):  
Cognitive Impairment ◽  
Adverse Events ◽  
The United States ◽  
Narrative Review ◽  
Lipid Lowering ◽  
Patient Specific ◽  
Proprotein Convertase ◽  
Pcsk9 Inhibitors ◽  
Pcsk9 Inhibitor ◽  
Receptor Modulation

Neurocognitive adverse events have been observed with the widespread use of 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors or “statins,” which reduce low-density lipoprotein cholesterol (LDL-C) levels and subsequently cardiovascular risk. The United States Food and Drug Association directed manufacturers of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors to monitor for neurocognitive adverse events due to their potent effects on LDL-C reduction, which is a proposed mechanism for neuronal cell dysfunction. Other proposed mechanisms for PCSK9 inhibitor-associated neurocognitive adverse events include N-methyl-d-aspartate receptor modulation, dysregulation of lipid and glucose metabolism, and patient-specific risk factors for cognitive impairment. The purpose of this narrative review article is to describe the proposed mechanisms, incidence of neurocognitive adverse events from phase II and III trials for PCSK9 inhibitors, neurocognitive assessments utilized in clinical trials, and clinical implications. Given the increasing prevalence of PCSK9 inhibitor use and the neurocognitive adverse events observed with prior lipid-lowering therapies, clinicians should be aware of the risks associated with PCSK9 inhibitors, especially when therapy is indicated for patients at high risk for cardiovascular events. Overall, the incidence of PCSK9 inhibitor-associated neurocognitive appears to be uncommon. However, additional prospective studies evaluating cognitive impairment may be beneficial to determine the long-term safety of these agents.

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

Correlation between cognitive impairment and cerebral hemodynamic disturbances on perfusion magnetic resonance imaging in European adults with moyamoya disease

2010 ◽  
Vol 113 (4) ◽  
pp. 753-759 ◽  
Author(s):  
Lionel Calviere ◽  
Isabelle Catalaa ◽  
Fabienne Marlats ◽  
Alain Viguier ◽  
Fabrice Bonneville ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Moyamoya Disease ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Perfusion Magnetic Resonance Imaging ◽  
Cerebrovascular Reserve ◽  
Cerebral Hemodynamic ◽  
Perfusion Mr ◽  
Perfusion Mr Imaging ◽  
Relationship Of

Object Although cognitive impairment has been reported in adults with moyamoya disease (MMD), its relationship with cerebral hemodynamic disturbances has not been investigated. The aims of the present study were to confirm the presence of dysexecutive cognitive syndrome (DCS) in adults with MMD and to explore the relationship of DCS with frontal lobe perfusion as measured by perfusion MR imaging. Methods Cerebral blood volume (CBV) ratio and mean transit time delay were measured in frontal and temporoparietal regions using the cerebellum as a reference region in 10 European adults with MMD. In addition, the authors calculated the cerebrovascular reserve (CVR) using the CBV ratio and the acetazolamide challenge. All patients underwent a standardized neuropsychological assessment test battery. The authors defined DCS as an impairment shown on 3 tests or more of executive function. Results The authors found DCS in 6 patients. The frontal CVR was lower in patients with DCS than in patients without DCS (mean ± SD: −13.5 ± 13.2% and 20.3 ± 21.3%; p = 0.019, Mann-Whitney U-test). Other parameters of frontal perfusion and temporoparietal CVR were not correlated with DCS. Conclusions The authors' findings suggest that DCS is common in European adults with MMD and may be related to frontal perfusion impairment.

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

Neuronal Activity Topography Parameters as a Marker for Differentiating Vascular Cognitive Impairment in Carotid Stenosis

2014 ◽  
Vol 23 (9) ◽  
pp. 2384-2390 ◽  
Author(s):  
Takashi Shibata ◽  
Toshimitu Musha ◽  
Michiya Kubo ◽  
Yukio Horie ◽  
Takashi Asahi ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Carotid Stenosis ◽  
Neuronal Activity ◽  
Vascular Cognitive Impairment

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

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