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

https://doi.org/10.14412/2074-2711-2015-1-43-48

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Abstract

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


References

1. Верещагин НВ, Моргунов ВА, Гулевская ТС. Патология головного мозга при атеросклерозе и артериальной гипертонии. Москва: Медицина; 1997. С. 8–61 [Vereshchagin NV, Morgunov VA, Gulevskaya TS. Patologiya golovnogo mozga pri ateroskleroze i arterial'noi gipertonii [Brain pathology in atherosclerosis and arterial hypertension]. Moscow: Meditsina; 2009. P. 8–61].

2. Лелюк ВГ, Лелюк СЭ. Ультразвуковая ангиология. Москва: Реальное время; 2003. 343 с. [Lelyuk VG, Lelyuk SE. Ul'trazvukovaya angiologiya [Ultrasonic angiology]. Moscow: Real'noe vremya; 2003. 343 p.].

3. Чеботарев АФ, Коркушко ОВ, Маньковский НБ. Атеросклероз и возраст. Ленинград: Медицина; 1982. С. 3–52. [Chebotarev AF, Korkushko OV, Man'kovskii NB. Ateroskleroz i vozrast [Atherosclerosis and age]. Leningrad: Meditsina; 1982. P. 3–52].

4. Суслина ЗА, редактор. Очерки ангионеврологии. Москва: Атмосфера; 2005. 368 с. [Suslina ZA, editor. Ocherki angionevrologii [Essays on angioneurology]. Moscow: Atmosfera; 2005. 386 p.].

5. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high grade stenosis. N Engl J Med. 1991 Aug 15;325(7):445–53.

6. Albert MS1, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011 May;7(3):270–9. doi: 10.1016/j.jalz.2011.03.008. Epub 2011 Apr 21.

7. Парфенов ВА, Чердак МА, Вахнина НВ и др. Когнитивные расстройства у пациентов, перенесших ишемический инсульт. Неврология, нейропсихиатрия, психосоматика. 2012;(2S):17–22. [Parfenov VA, Cherdak MA, Vakhnina NV, et al. Cognitive impairments in patients with prior ischemic stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;(2S):17–22. (In Russ.)]. doi: http://dx.doi.org/10.14412/2074-27112012-2504

8. Парфенов ВА, Вербицкая СВ. Факторы риска и профилактика инсульта при фибрилляции предсердий. Неврология, нейропсихиатрия, психосоматика. 2014;(3):55–60. [Parfenov VA, Verbitskaya SV. The risk factors and prevention of stroke in atrial fibrillation. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2014;(3):55–60. (In Russ.)]. doi: http://dx.doi.org/10.14412/2074-2711-2014-3

9. Неверовский ДВ, Случевская СФ, Парфенов ВА. Дифференциальный диагноз дисциркуляторной энцефалопатии в амбулаторной практике. Неврология, нейропсихиатрия, психосоматика. 2013;(2):38–42. [Neverovskii DV, Sluchevskaya SF, Parfenov VA. Differential diagnosis of dyscirculatory encephalopathy in outpatient practice. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;(2):38–42. (In Russ.)]. doi: http://dx.doi. org/10.14412/2074-2711-2013-2411

10. Левин ОС. Диагностика и лечение дисциркуляторной энцефалопатии. Mетодическое пособие. Москва: МИА; 2010. С. 1–8. [Levin OS. Diagnostika i lechenie distsirkulyatornoi entsefalopatii. Metodicheskoe posobie [Diagnosis and treatment of dyscirculatory encephalopathy. Methodical manual]. Moscow: MIA; 2010. P. 1–8].

11. Вахнина НВ. Сосудистые когнитивные нарушения. Неврология, нейропсихиатрия, психосоматика. 2014;(1):74–9. [Vakhnina NV. Vascular cognitive impairment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2014;(1):74–9. (In Russ.)]. doi: http://dx.doi.org/10.14412/ 2074-2711-2014-1-74-79

12. Лобзин ВЮ, Емелин АЮ, Воробьeв СВ, Лупанов ИА. Современные подходы к диагностике, профилактике и терапии когнитивных нарушений при дисциркуляторной энцефалопатии. Неврология, нейропсихиатрия, психосоматика. 2014;(2):51–6. [Lobzin VYu, Emelin AYu, Vorob'ev SV, Lupanov IA. Current approaches to the diagnosis, prevention, and therapy of cognitive impairments in vascular encephalopathy. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2014;(2):51–6. (In Russ.)]. doi: http://dx.doi.org/ 10.14412/2074-2711-2014-2-51-56


For citation:


Khasanova D.R., Zhitkova Y.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.) https://doi.org/10.14412/2074-2711-2015-1-43-48

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ISSN 2074-2711 (Print)
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