scholarly journals Subclinical Carotid Artery Atherosclerosis and Cognitive Function: A Mini-Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Håkon Ihle-Hansen ◽  
Hege Ihle-Hansen ◽  
Else Charlotte Sandset ◽  
Guri Hagberg
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Carotid Artery ◽  
Independent Risk Factor ◽  
Carotid Atherosclerosis ◽  
Vascular Risk ◽  
Risk Factor Management ◽  
Carotid Artery Atherosclerosis ◽  
Non Invasive

Carotid artery atherosclerosis, the result of a multitude of vascular risk factors, is a promising marker for use in risk stratification. Recent evidence suggests that carotid artery atherosclerosis affects cognitive function and is an independent risk factor for the development of cognitive impairment. Both atherosclerosis and cognitive impairment develop over a prolonged period (years), and due to the aging population, markers to identify persons at risk are needed. Carotid artery atherosclerosis can easily be visualized using non-invasive ultrasound, potentially enabling early and intensified risk factor management to preserve cognitive function or delay further decline. However, the burden of atherosclerosis and temporal exposure required to pose a risk of cognitive impairment is unclear. This mini-review aims to explore the available evidence on the association between carotid atherosclerosis and cognition, and furthermore identify the remaining gaps in knowledge.

scholarly journals Association Between Z Drugs Use and Risk of Cognitive Impairment in Middle-Aged and Older Patients With Chronic Insomnia

2021 ◽  
Vol 15 ◽  
Author(s):  
Fang Guo ◽  
Li Yi ◽  
Wei Zhang ◽  
Zhi-Jie Bian ◽  
Yong-Bo Zhang
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Drug Use ◽  
Older Patients ◽  
Independent Risk Factor ◽  
Drug Exposure ◽  
Chronic Insomnia ◽  
Middle Aged ◽  
Global Cognitive Function

Background: Benzodiazepines (BZDs) and Non-BZDs (NBZDs) have been widely used for patients with chronic insomnia. Long-term uses of BZDs may cause cognitive impairment and increase the risk for dementia in older patients. NBZD as an agonist of the GABAA receptor complex includes eszopiclone, zopiclone, zolpidem, and zaleplon, also collectively known as Z drugs. However, evaluations for an association between cognitive impairment and Z drug use have been limitedly performed. This study aimed to investigate the association between the risk of cognitive decline and exposure to Z drugs in middle-aged and older patients with chronic insomnia.Methods: Investigations were performed on patients with chronic insomnia who visited the outpatient Department of Neurology, Beijing Friendship Hospital, and were assessed for the global cognitive function (MoCA) and memory (AVLT), executive function (TMT-B), visuospatial ability (CDT), verbal function (BNT-30), and attention (DST). Multiple regression analysis was conducted to determine the independent factors of cognition and evaluated the effect of Z drug use (zolpidem and zopiclone) on cognition.Results: A total of 120 subjects were identified. In our analysis, BZD exposure density (P = 0.025, OR = 1.43, 95% CI, 1.25–1.86) was an independent risk factor of cognitive impairment in middle-aged and older patients with chronic insomnia. Neither Z drug use (P = 0.103) nor Z drug exposure density (P = 0.765) correlated with global cognitive function. Moreover, there was a positive association between Z drug use and attention [(P = 0.002, OR = 0.42, 95% CI, 0.24–0.73)]. Additionally, income level (P = 0.001, OR = 0.23, 95% CI, 0.10–0.53), severity of insomnia (P = 0.019, OR = 1.20, 95% CI, 1.03–1.40) and age (P = 0.044, OR = 1.07, 95% CI, 1.00–1.14) were also independent factors of global cognitive function.Conclusion: BZD exposure density was an independent risk factor of cognitive impairment in middle-aged and older patients with chronic insomnia, but no correlation was found between Z drug use and cognitive impairment. Moreover, the use of Z drugs seemed to be associated with protection for attention. The use for prescription of BZDs, in this case, should be avoided or limited to low doses. Due to the addiction and tolerance, Z drugs should also be prescribed with great caution in middle-aged and elderly patients.

scholarly journals Can Cardiovascular Risk Management be improved by Shared Care with General Practice to Prevent Cognitive Decline Following Stroke/TIA? A feasibility randomised controlled Trial (SERVED Memory)

2020 ◽  
Author(s):  
William Davison ◽  
Phyo K Myint ◽  
Yoon K Loke ◽  
Garth Ravenhill ◽  
David A Turner ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Randomised Trial ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Risk Factor Management ◽  
Post Stroke ◽  
Observational Cohort ◽  
Normal Cognition

Abstract BackgroundCognitive impairment and dementia following cerebrovascular disease are increasingly common in the UK. One potential strategy to prevent post-stroke cognitive decline is multimodal vascular risk factor management. However, its efficacy remains uncertain and its application in vulnerable patients with incident cerebrovascular disease and early cognitive impairment has not been assessed.The primary aim of this study was to assess the feasibility of recruitment and retention of patients with early cognitive impairment post-stroke or transient ischaemic attack (TIA) to a trial of enhanced vascular risk factor management combining primary and secondary care.MethodsIn this single centre, open label trial adults with a recent stroke or TIA and mild cognitive impairment (MCI) were randomised 1:1 to a three-monthly multimodal vascular risk factor intervention jointly delivered by the trial team and General Practitioner (GP), or control (defined as usual care from the GP). Chosen risk factors were blood pressure (BP), total cholesterol, blood glucose (HbA1C) in those with diabetes, and heart rate and adequacy of anticoagulation in those with atrial fibrillation (AF). Similar patients with normal cognition were enrolled in an embedded observational cohort and also received usual care from the GP. Repeat cognitive screening was undertaken in all participants after 12 months.ResultsSeventy three participants were recruited to the randomised trial and 94 to the observational cohort (21.8% of those screened). From the randomised trial 35/73 (47.9%) dropped out before final follow-up. In all groups guideline based rates of risk factor control were mostly poor at baseline and did not significantly improve during follow-up. The observational cohort demonstrated greater decline in cognitive test scores at 12 months, with no difference between the randomised groups.ConclusionsRecruitment to such a study was feasible, but retention of participants was difficult and generally poor rates of risk factor control suggested insufficient application of the intervention. Consequently, successful scaling up of the trial would require protocol changes with less reliance on primary care services. Any future trial should include participants with normal cognition post-stroke as they may be at greatest risk of cognitive decline.Trial RegistrationISRCTN, ISRCTN42688361. Registered 16 April 2015, https://www.isrctn.com/ISRCTN42688361

scholarly journals Can cardiovascular risk management be improved by shared care with general practice to prevent cognitive decline following stroke/TIA? A feasibility randomised controlled trial (SERVED memory)

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
William J. Davison ◽  
Phyo K. Myint ◽  
Yoon K. Loke ◽  
Garth Ravenhill ◽  
David Turner ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Randomised Trial ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Risk Factor Management ◽  
Post Stroke ◽  
Observational Cohort

Abstract Background Cognitive impairment and dementia following cerebrovascular disease are increasingly common in the UK. One potential strategy to prevent post-stroke cognitive decline is multimodal vascular risk factor management. However, its efficacy remains uncertain and its application in vulnerable patients with incident cerebrovascular disease and early cognitive impairment has not been assessed. The primary aim of this study was to assess the feasibility of recruitment and retention of patients with early cognitive impairment post-stroke or transient ischaemic attack (TIA) to a trial of enhanced vascular risk factor management combining primary and secondary care. Methods In this single centre, open label trial adults with a recent stroke or TIA and mild cognitive impairment (MCI) were randomised 1:1 to a three-monthly multimodal vascular risk factor intervention jointly delivered by the trial team and General Practitioner (GP), or control (defined as usual care from the GP). Chosen risk factors were blood pressure (BP), total cholesterol, blood glucose (HbA1C) in those with diabetes, and heart rate and adequacy of anticoagulation in those with atrial fibrillation (AF). Similar patients with normal cognition were enrolled in an embedded observational cohort and also received usual care from the GP. Repeat cognitive screening was undertaken in all participants after 12 months. Results Seventy three participants were recruited to the randomised trial and 94 to the observational cohort (21.8% of those screened). From the randomised trial 35/73 (47.9%) dropped out before final follow-up. In all groups guideline based rates of risk factor control were mostly poor at baseline and did not significantly improve during follow-up. The observational cohort demonstrated greater decline in cognitive test scores at 12 months, with no difference between the randomised groups. Conclusions Recruitment to such a study was feasible, but retention of participants was difficult and generally poor rates of risk factor control suggested insufficient application of the intervention. Consequently, successful scaling up of the trial would require protocol changes with less reliance on primary care services. Any future trial should include participants with normal cognition post-stroke as they may be at greatest risk of cognitive decline. Trial registration ISRCTN, ISRCTN42688361. Registered 16 April 2015.

scholarly journals Cognitive Functions in Patients after Carotid Artery Revascularization—A Narrative Review

2021 ◽  
Vol 11 (10) ◽  
pp. 1307
Author(s):  
Magdalena Piegza ◽  
Gniewko Więckiewicz ◽  
Dawid Wierzba ◽  
Jacek Piegza
Keyword(s):  
Cognitive Function ◽  
Carotid Artery ◽  
Cognitive Assessment ◽  
Neuropsychological Tests ◽  
Independent Risk Factor ◽  
Cerebral Hypoperfusion ◽  
Cognitive Deterioration ◽  
Carotid Revascularization ◽  
Neurocognitive Functions ◽  
Precise Assessment

Carotid revascularization may lead to improved cognitive function beyond stroke prevention. This article summarizes the conclusions from available studies on the effects of carotid reperfusion procedures on cognitive function. The papers cited used different neuropsychological tests for cognitive assessment, resulting in different methodologies and the results obtained were not always convergent. However, most studies reported an improvement in neurocognitive abilities after both vascular interventions, but a more precise assessment of the specific benefits is still awaited. Clinical determinants to predict the effects of these treatments on cognitive function are still being sought, but results are not yet satisfactory. In view of these studies, carotid stenosis seems to be an independent risk factor for cognitive deterioration, and the main mechanisms responsible are embolism and cerebral hypoperfusion. The aim of this study is to order the knowledge about the effects of carotid artery stenting (CAS) and endarterectomy (CEA) on neurocognitive functions and to verify the usefulness of using these treatments.

Carotid artery atherosclerosis is correlated with cognitive impairment in an elderly urban Chinese non-stroke population

2013 ◽  
Vol 20 (11) ◽  
pp. 1571-1575 ◽  
Author(s):  
Jing Xiang ◽  
Tao Zhang ◽  
Qing-wu Yang ◽  
Juan Liu ◽  
Yong Chen ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Carotid Artery ◽  
Carotid Artery Atherosclerosis ◽  
Stroke Population
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