Cognitive function in patients with cerebral large arterial disease

Abstract

We prospectively investigated the cognitive function in patients with cerebral large artery disease (CLAD). We registered 176 patients without severe neurological symptoms who had apparent carotid artery or middle cerebral artery occlusive disease between October, 2011 and December 2013. We excluded those with dementia. The cognitive functions of the patients were measured with Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Their white matter lesion and microbleeds evaluated with MRI and cerebral blood flow were also assessed. The factors associated with cognitive impairment were analyzed using univariate and multivariate analyses. Furthermore, the factors associated with sub-scores (ex. executive function, attention, memory) were assessed. Of the patients with carotid stenosis, pre-and post-operative changes of cognition were compared with those performed carotid endarterectomy (CEA) while the cognition was also compared between at initial and at 1 year after. As a result, the cognitive impairment defined with 25 points or less of MoCA reached 77.3 percent. Multivariate analysis indicated that the factors associated with cognitive impairment were older age, drinking habit, decreased cerebral blood flow and the grading of periventricular white matter. Meanwhile, the cognitive function was elevated from 21 before CEA to 23 one year after CEA (P=0.006), while cognitive function at 1 year after did not improve significantly compared with that at initial (P=0.47). Thus, we were able to elucidate the characteristics and factors associated with cognitive function in patients with CLAD.