Cognitive and Physical Performance in Patients with Asymptomatic Carotid Artery Stenosis and Occlusion
Cognitive and Physical Performance in Patients with Asymptomatic Carotid Artery Stenosis and Occlusion.
This dissertation project presents a review of the anatomy and functional relationships of the circulatory territory of the internal carotid artery, and considers the functional changes that can occur when there is disease within this system. The project has two specific aims which are addressed in two articles. The first specific aim is to determine if persons with asymptomatic carotid artery disease (high moderate stenosis through occlusion) demonstrate deficits in cognition and on physical performance measures. The second specific aim is to determine if there is a correlation between the cognitive measures and the instrumental activities of daily living in these asymptomatic patients.
In the first article, the purpose of the study was to determine if patients with asymptomatic carotid artery stenosis and occlusion demonstrate deficits in cognitive and physical performance. The relationship between cognitive measures and performance of instrumental activities of daily living was examined. Thirty-nine patients with asymptomatic carotid artery stenosis of moderate and severe degrees, or occlusion were tested. Cognition was assessed via the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Executive Interview (EXIT). Physical performance was assessed via the Physical Performance Test (PPT), and the Lawton Instrumental Activities of Daily Living. Deficits in cognitive function were found on the RBANS for all levels of stenosis and occluded subgroups in the domains of visuospatial/constructional and delayed memory, in the moderate stenosis subgroup in immediate memory, attention and visuospatial/constructional, and in the severe subgroup in all domains except language. There were no significant findings on the EXIT. Decreased performance on the PPT was identified in all 3 subgroups. The Lawton IADL did not identify any decrease in IADL performance.
The second article included a more definitive examination of physical performance. Physical performance was assessed via the 9-item and 7-item Physical Performance Test (PPT). Individual tasks were also timed. Patients with asymptomatic carotid artery stenosis and occlusion demonstrated less than optimal performance on the PPT ( 9-item, 27/36; 7-item 21/28). Simulated eating was the slowest task to perform for the patients with moderate stenosis.
Deficits in cognitive function were found in this observational study of patients with asymptomatic carotid artery stenosis and occlusion. Additionally, patients exhibited changes in function as indicated by their performance on the PPT. This may be indicative of preclinical disability, and a potential symptomatic status of the patient. Both articles demonstrate that asymptomatic patients may not be truly asymptomatic. This potential change in status needs to be considered as patients are being evaluated for interventions to manage their carotid artery disease.
Advisor:Dr. Anthony Delitto; Dr. Pamela Duncan; Dr. James Gebel; Dr. Howard Yonas; Dr. Susan Whitney
School:University of Pittsburgh
School Location:USA - Pennsylvania
Source Type:Master's Thesis
Date of Publication:05/24/2004