Affiliations: [a] The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel | [b] Department of Neurology, Hospital das Clínicas, São Paulo University, São Paulo, Brazil | [c] Department of Neurology, Boston University School of Medicine, Boston, MA, USA | [d] Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel | [e] Department of Psychiatry at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
Correspondence:
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Correspondence to: Prof. David Tanne, MD, Department of Neurology and Joseph Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Tel.: +97 235302069; Fax: +97 236356087; [email protected]
Abstract: Background and Objective: Patients with pre-existing atherothrombotic disease are prone to cognitive impairment. We tested whether impaired cerebrovascular reactivity (CVR), a marker of cerebral microvascular hemodynamic dysfunction, is associated with poorer cognitive scores among patients with and without carotid large-vessel disease. Methods: A subgroup of non-demented patients with chronic coronary heart disease followed-up for 15 ± 3 years was assessed for cognitive function (Neurotrax Computerized Cognitive Battery; scaled to an IQ style scale with a mean of 100 and SD of 15) and for CVR using the breath-holding index (BHI) with transcranial Doppler and for carotid plaques using ultrasound. We assessed cognitive scores in specific domains in patients with and without impaired CVR (BHI <0.47; bottom quartile). Results: Among 415 patients (mean age 71.7 ± 6.2 y) median BHI was 0.73 (25% 0.47, 75% 1.04). Impaired CVR was associated with diabetes and peripheral artery disease. Adjusting for potential confounders, impaired CVR was associated with lower executive function (p = 0.02) and global cognitive scores (p = 0.04). There was an interaction with carotid large-vessel disease for executive function (p < 0.001), memory (p = 0.03), and global cognitive scores (p = 0.02). In the carotid large-vessel disease group there were pronounced differences by CVR status in executive function (p < 0.001), memory (p = 0.02), attention (p < 0.001), and global cognitive scores (p = 0.001). Conclusion: Impaired CVR, a marker of cerebral microvascular dysfunction, is associated with poorer cognitive functions and in particular executive dysfunction among non-demented patients with concomitant carotid large-vessel disease. These findings emphasize the importance of cerebral hemodynamics in cognitive performance.
