The influence of atherosclerotic changes and risk factors on the cognitive status of patients with asymptomatic carotid artery stenosis

Background
Carotid atherosclerosis is a major risk factor for cognitive decline. Carotid artery stenosis and intima-media thickness (IMT) indicate disease severity, while vascular and inflammatory factors further influence dementia risk.
Methods
In a prospective study, 180 patients aged 50–70 years were divided into three groups: (1) asymptomatic carotid stenosis without transient ischemic attack (TIA) or infarction, (2) symptomatic stenosis with TIA or infarction, and (3) controls with normal carotid findings. Vascular risk factors, diabetes, hypercholesterolemia, and inflammatory markers (tumor necrosis factor-α, C-reactive protein, fibrinogen, leukocyte sedimentation) were assessed. Carotid ultrasound evaluated stenosis, cognitive function was measured with the Addenbrooke’s Cognitive Examination-Revised (ACE-R), and brain CT/MRI identified ischemic lesions.
Results
Asymptomatic carotid stenosis was independently associated with cognitive impairment. Severe right-sided stenosis increased the risk of severe cognitive decline 14-fold, while severe left-sided stenosis raised the risk nearly 20-fold.
Conclusion
Carotid stenosis strongly correlates with cognitive dysfunction, even in the absence of clinical cerebrovascular events. Early detection and monitoring of inflammatory activation may help prevent cognitive decline and improve long-term neurological outcomes.
Key words: atherosclerosis, carotid artery stenosis, cognitive impairment, vascular risk factors.