Baseline Cognitive Impairment in Patients With Asymptomatic Carotid Stenosis in the CREST-2 Trial
| Autor: | Randolph S. Marshall, Jenifer H. Voeks, Ronald M. Lazar, James F. Meschia, Brajesh K. Lal, Claudia S. Moy, George Howard, Virginia J. Howard, Michael R. Jones, Thomas G. Brott, Seemant Chaturvedi, Jennifer J. Manly, Terina Myers, Wayne M. Clark, Donald Heck, Virginia G. Wadley |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Population Affect (psychology) Asymptomatic Article Internal medicine Carotid artery disease medicine Humans Carotid Stenosis Cognitive Dysfunction education Stroke Aged Randomized Controlled Trials as Topic Advanced and Specialized Nursing education.field_of_study business.industry Cognition Middle Aged medicine.disease Stenosis Cardiology Female Crest Neurology (clinical) medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Stroke |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.120.032972 |
| Popis: | 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 P =0.015). Lower performance was attributed largely to Word List Recall ( P 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. |
| Databáze: | OpenAIRE |
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