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Importance of atherosclerotic stenotic lesion of the brachiocephalic arteries in the development of cognitive impairments

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The impact of the pattern of atherosclerotic stenotic lesion on the clinical presentation of cognitive impairments (CIs) has been inadequately investigated.
Objective: to estimate the impact of the degree and site of an atherosclerotic stenotic process on cerebral perfusion and cognitive functions.
Patients and methods. A total of 123 patients (65 men and 58 women) aged 50 to 75 years with brachiocephalic artery stenosis of at least 40%, without hypertension, diabetes mellitus, or other systemic vascular pathology were examined. The structural state of the brain substance and the state of cerebral blood flow were evaluated by magnetic resonance imaging and magnetic resonance angiography. The scale described by P. Scheltens et al. was used to determine changes in the white matter. The site and degree of a stenotic process were estimated by extracranial and transcranial duplex scanning. CIs were identified applying a set of neuropsychological assessment scales. The Hamilton hospital depression rating scale was also employed. 
Results and discussion. Varying degrees of CIs were detected in the majority of the examinees with brachiocephalic artery atherosclerosis. The most severe CIs were associated with the involvement of parietal and frontal lobes. There was significant deterioration in cognitive functions with a higher percentage of stenosis: more severe CIs were seen in the presence of stenosis in the carotid system than in those in the vertebrobasilar bed. In addition, the patients with concomitant stenoses and tandem stenoses were observed to have more pronounced CIs than those with single artery stenosis. Cerebral atherosclerosis is shown to be one of the major risk factors for CIs. Not only the degree of stenoses, but also to a greater extent their site was observed to impact the occurrence of CIs accompanied by the development of a perfusion deficit in the specific vascular beds. The determination of the pattern of a stenotic process will be able to predict the development of CIs in patients with atherosclerosis and to choose an appropriate treatment policy. 

About the Authors

D. R. Khasanova
Interregional Clinical and Diagnostic Center; 12A, Karbyshev St., Kazan 420101; Department of Neurology and Neurosurgery, Faculty for Advanced Training and Professional Retraining of Specialists, Kazan State Medical University, Ministry of Health of Russia, Kazan, Russia; 49, Butlerov St., Kazan 420012
Russian Federation

Yu. V. Zhitkova
Interregional Clinical and Diagnostic Center; 12A, Karbyshev St., Kazan 420101;
Russian Federation

A. A. Gasparyan
Interregional Clinical and Diagnostic Center; 12A, Karbyshev St., Kazan 420101;
Russian Federation


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For citations:

Khasanova D.R., Zhitkova Yu.V., Gasparyan A.A. Importance of atherosclerotic stenotic lesion of the brachiocephalic arteries in the development of cognitive impairments. Neurology, Neuropsychiatry, Psychosomatics. 2015;7(1):43-48. (In Russ.)

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ISSN 2074-2711 (Print)
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