Early cognitive decline in symptomatic carotid stenosis is related to plaque inflammation and concomitant intracranial stenosis (P4.258)

Objective: To evaluate cognitive parameters of patients with symptomatic carotid stenosis at baseline and their natural course during 90 days of follow up. Background: Symptomatic carotid stenosis is associated with an increased risk of early stroke recurrence. Post-stroke vascular cognitive impairment is highly prevalent with significant functional consequences. However, reliable biomarkers for early prediction of cognitive decline are not well established. We postulated that regional hypoperfusion due to carotid stenosis would impair cognitive performance. Design/Methods: This ongoing prospective study included patients within 30 days of recent stroke and ipsilateral carotid stenosis (≥50%). Data regarding demographics and vascular risk factors were recorded. Cognitive parameters were assessed with the 30-point mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA). All patients underwent carotid duplex sonography and 18-fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) of the carotid arteries. Embolic potential of the carotid plaque was estimated by the presence of spontaneous microembolic signals (MES) on extended transcranial Doppler monitoring of the middle cerebral arteries. Patients were followed prospectively for change in cognitive parameters. Results: Out of 39 patients, 8 (21%) demonstrated deterioration of their cognitive parameters (MMSE in 6, MOCA in 5 and both in 7) during 90-day follow up. Only high Standard Uptake Value (SUV) on PET (3.74 g/ml in cognitive-deterioration group versus 1.66 g/ml in the unaffected group; p=0.01) and presence of concomitant intracranial stenosis (p=0.01) were associated with cognitive deterioration. Of the 7 cases who underwent carotid revascularization, 5 (71%) demonstrated improved cognitive performance at day 90. Conclusions: Early cognitive decline is common among patients with symptomatic stenosis of the extracranial carotid artery, especially when associated with concomitant intracranial stenosis and plaque inflammation. Study Supported by: This study is supported by a grant from the National Medical Research Council, Singapore. Disclosure: Dr. Tan has nothing to disclose. Dr. Bharatendu has nothing to disclose. Dr. Paliwal has nothing to disclose. Dr. Teoh has nothing to disclose. Dr. Chan has nothing to disclose. Dr. Dong has nothing to disclose. Dr. Sinha has nothing to disclose. Dr. Sharma has nothing to disclose.