The value of atherosclerotic stenizing lesions of the brachiocephalous arteries in the formation of cognitive impairment

Author:

Khasanova D.R., Zhitkova Yu.V., Gasparyan A.A.

Place of publication:

NEUROLOGY. NEUROPSYCHIATRY. Psychosomatics, 2015

The influence of the nature of the atherosclerotic stenizing lesion on the clinical picture of cognitive impairment (KN) has not been sufficiently studied.

The aim of the study was to assess the influence of the degree and localization of the atherosclerotic stenotic process on cerebral perfusion and the state of cognitive functions.

Patients and methods. The study included 123 patients (65 men and 58 women) aged 50 to 75 years with at least 40% stenosis of the brachiocephalic arteries and no history of hypertension, diabetes, or other systemic vascular disease. The structural state of the brain and cerebral blood flow were assessed using magnetic resonance imaging and magnetic resonance angiography. The Scheltens scale by P. et al. was used to determine white matter changes. The location and extent of the stenotic process were assessed using extracranial and transcranial duplex scanning. CI was determined using a set of neuropsychological scales. The Hamilton Depression Rating Scale was also used.

Results and discussion. The majority of patients examined with atherosclerosis of the brachiocephalic arteries showed varying degrees of cognitive impairment. The most severe cognitive impairment was associated with damage to the parietal and frontal lobes. A significant deterioration in cognitive function was observed as the percentage of stenosis increased: with stenoses in the carotid system, more severe cognitive impairment was observed than with stenoses in the vertebrobasilar system. Furthermore, patients with combined and tandem stenoses had more pronounced cognitive impairment compared to patients with stenosis of a single artery. Cerebral atherosclerosis is shown to be one of the main risk factors for the development of cognitive impairment. The influence of not only the degree but, to a greater extent, the location of stenosis on the development of cognitive impairment, accompanied by the development of perfusion deficit in specific vascular beds, was noted. Determining the nature of the stenotic process will allow us to predict the development of cognitive impairment in patients with atherosclerosis and select appropriate treatment tactics.

Key words: atherosclerosis; brachiocephalic artery stenosis; cognitive impairment.