Background and Purpose:Studies of carotid artery disease have suggested that high-grade stenosis can affect cognition, even without stroke. The presence and degree of cognitive impairment in such patients have not been reported and compared with a demographically matched population-based cohort.Methods:We studied cognition in 1000 consecutive CREST-2 (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial) patients, a treatment trial for asymptomatic carotid disease. Cognitive assessment was after randomization but before assigned treatment. The cognitive battery was developed in the general population REGARDS Study (Reasons for Geographic and Racial Differences in Stroke), involving Word List Learning Sum, Word List Recall, and Word List fluency for animal names and the letter F. The carotid stenosis patients were >45 years old with ≥70% asymptomatic carotid stenosis and no history of prevalent stroke. The distribution of cognitive performance for the patients was standardized, accounting for age, race, and education using performance from REGARDS, and after further adjustment for hypertension, diabetes, dyslipidemia, and smoking. Using the Wald Test, we tabulated the proportion of Z scores less than the anticipated deviate for the population-based cohort for representative percentiles.Results:There were 786 baseline assessments. Mean age was 70 years, 58% men, and 52% right-sided stenosis. The overall Z score for patients was significantly below expected for higher percentiles (P<0.0001 for 50th, 75th, and 95th percentiles) and marginally below expected for the 25th percentile (P=0.015). Lower performance was attributed largely to Word List Recall (P<0.0001 for all percentiles) and for Word List Learning (50th, 75th, and 95th percentiles below expected, P≤0.01). The scores for left versus right carotid disease were similar.Conclusions:Baseline cognition of patients with severe carotid stenosis showed below normal cognition compared to the population-based cohort, controlling for demographic and cardiovascular risk factors. This cohort represents the largest group to date to demonstrate that poorer cognition, especially memory, in this disease.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02089217.

中文翻译：

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CREST-2 试验中无症状颈动脉狭窄患者的基线认知障碍

背景和目的：颈动脉疾病的研究表明，即使没有卒中，严重的狭窄也会影响认知。此类患者认知障碍的存在和程度尚未报告，也未与人口统计学匹配的基于人群的队列进行比较。方法：我们研究了 1000 名连续的 CREST-2（无症状颈动脉狭窄试验的颈动脉血运重建和医疗管理）患者的认知，无症状颈动脉疾病的治疗试验。认知评估在随机化之后但在指定治疗之前进行。认知电池是在一般人群 REGARDS 研究（中风的地理和种族差异的原因）中开发的，涉及动物名称和字母 F 的单词列表学习总和、单词列表召回和单词列表流利度。颈动脉狭窄患者年龄 >45 岁，≥70% 无症状颈动脉狭窄，无中风史。患者的认知表现分布是标准化的，使用 REGARDS 的表现考虑年龄、种族和教育，并在进一步调整高血压、糖尿病、血脂异常和吸烟后。使用 Wald 检验，我们列出了Z分数小于基于人口的队列的代表性百分位数的预期偏差。结果：有 786 项基线评估。平均年龄为 70 岁，男性占 58%，右侧狭窄占 52%。患者的总体Z评分显着低于较高百分位数的预期值（第 50、75 和 95 个百分位数的P <0.0001）并且略低于第 25 个百分位数的预期值（ P = 0.015）。较低的性能主要归因于单词列表召回（所有百分位数P <0.0001）和单词列表学习（低于预期的第 50、75 和 95 个百分位数，P≤0.01)。左颈动脉疾病与右颈动脉疾病的评分相似。结论：与基于人口的队列相比，严重颈动脉狭窄患者的基线认知显示低于正常认知，控制了人口统计学和心血管危险因素。这个队列代表了迄今为止证明这种疾病的认知能力，尤其是记忆力较差的最大群体。注册：URL：https://www.clinicaltrials.gov；唯一标识符：NCT02089217。