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The Journal of Cardiovascular Surgery 2023 April;64(2):167-73

DOI: 10.23736/S0021-9509.23.12620-6


lingua: Inglese

Asymptomatic carotid stenosis and cognitive impairment

Kosmas I. PARASKEVAS 1 , Dimitri P. MIKHAILIDIS 2, Francesco SPINELLI 3, Gianluca FAGGIOLI 4, Luca SABA 5, Mauro SILVESTRINI 6, Alexei SVETLIKOV 7, Francesco STILO 3, Rodolfo PINI 4, Piotr MYRCHA 8, Vincenzo DI LAZZARO 9, Pier L. ANTIGNANI 10, Pavel POREDOS 11, Gaetano LANZA 12

1 Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece; 2 Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK; 3 Division of Vascular Surgery, Campus Bio-Medico University of Rome, Rome, Italy; 4 Department of Vascular Surgery, IRCCS S. Orsola Malpighi Polyclinic, DIMEC - University of Bologna, Bologna, Italy; 5 Department of Radiology, University Hospital of Cagliari, Cagliari, Italy; 6 Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy; 7 Division of Vascular and Endovascular Surgery, North-Western Scientific Clinical Center of Federal Medical Biological Agency of Russia, St. Petersburg, Russia; 8 Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland; 9 Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy; 10 Vascular Center, Nuova Villa Claudia, Rome, Italy; 11 Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; 12 Department of Vascular Surgery, IRCSS MultiMedica Hospital, Castellanza, Varese, Italy

INTRODUCTION: The aim of this review was to assess the evidence supporting an association between asymptomatic carotid stenosis (ACS) with impaired cognitive function due to chronic cerebral hypoperfusion and/or silent cerebral embolization.
EVIDENCE ACQUISITION: PubMed/Medline, Embase and the Cochrane databases were searched up to December 1, 2022 to identify studies focusing on the association between ACS and cognitive function, as well as the mechanisms involved.
EVIDENCE SYNTHESIS: A total of 49 studies were identified. The evidence supports an association between ACS and progressive cognitive deterioration. The mechanisms involved in the cognitive decline associated with ACS include cerebral hypoperfusion and silent cerebral embolization. Irrespective of the mechanism involved, severe ACS is associated with a progressive decline in several aspects of cognitive function, including global cognition, memory and executive function.
CONCLUSIONS: Patients with ACS are at increased risk of developing a progressive decline in their cognitive function. The evidence from the present systematic review suggests that it may be inappropriate to consider ACS patients developing cognitive dysfunction as “asymptomatic”. Besides stroke, myocardial infarction and death rates, future studies should include evaluation of cognitive function as part of their outcomes.

KEY WORDS: Carotid stenosis; Cognition; Cognitive dysfunction; Dementia; Endarterectomy, carotid

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