Carotid disease, cognition, and aging: time to redefine asymptomatic disease?

Autor: Lineback CM; Department of Neurology, Stroke Division, University of Michigan Medical School, 1500 E Medical Dr., Ann Arbor, MI, USA. cmback@med.umich.edu.; Davee Department of Neurology, Stroke and Neurocritical Care Division, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. cmback@med.umich.edu., Stamm B; Davee Department of Neurology, Stroke and Neurocritical Care Division, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Sorond F; Davee Department of Neurology, Stroke and Neurocritical Care Division, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Caprio FZ; Davee Department of Neurology, Stroke and Neurocritical Care Division, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Jazyk: angličtina
Zdroj: GeroScience [Geroscience] 2023 Apr; Vol. 45 (2), pp. 719-725. Date of Electronic Publication: 2022 Nov 15.
DOI: 10.1007/s11357-022-00688-z
Abstrakt: There is an increasing appreciation of the vascular contributions in the development of age-related cognitive impairment and dementia 1,2 . Identifying risk and maintaining cognitive health for successful aging is ever relevant in our aging population. Carotid disease, a well-established risk factor for stroke and often a harbinger of other vascular disease states, is also emerging as another vascular risk factor for age-related cognitive decline. When combined with vascular risk factors, the incidence of age-related carotid disease can be as high as 70% 3,4 . Historically, carotid disease has been dichotomized into two large groups in trial design, outcome measurements, and treatment decisions: symptomatic and asymptomatic carotid artery stenosis. The dichotomous distinction between asymptomatic and symptomatic carotid stenosis based on existing definitions may be limiting the care we are able to provide for patients classified as "asymptomatic" from their carotid disease. Medically, we now know that these patients should be treated with the same intensive medical therapy as those with "symptomatic" carotid disease. Emerging data also shows that hypoperfusion from asymptomatic disease may lead to significant cognitive impairment in the aging population, and it is plausible that most "age-related" cognitive changes may be reflective of vascular impairment and neurovascular dysfunction. While over the past 30 years medical, surgical, and radiological advances have pushed the field of neurovascular disease to significantly reduce the number of ischemic strokes, we are far from any meaningful interventions to prevent vascular cognitive impairment. In addition to including cognitive outcome measures, future studies of carotid disease will also benefit from including advanced neuroimaging modalities not currently utilized in standard clinical imaging protocols, such as perfusion imaging and/or functional connectivity mapping, which may provide novel data to better assess for hypoxic-ischemic changes and neurovascular dysfunction across diffuse cognitive networks. While current recommendations advise against widespread population screening for asymptomatic carotid stenosis, emerging evidence linking carotid stenosis to cognitive impairment prompts us to re-consider our approach for older patients with vascular risk factors who are at risk for cognitive decline.
(© 2022. The Author(s), under exclusive licence to American Aging Association.)
Databáze: MEDLINE
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