[The relationship of carotid artery disease with mental and neurocognitive disorders].

Q3 Medicine
Psychiatrike = Psychiatriki Pub Date : 2024-06-28 Epub Date: 2022-05-26 DOI:10.22365/jpsych.2022.083
Christos Ch Liapis
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引用次数: 0

Abstract

Carotid stenosis constitutes a common vascular disease that significantly affects cerebral blood flow and thus is associated with patients' cognitive functions. Carotid revascularization techniques [carotid endarterectomy (CEA) and carotid artery stenting (CAS)] may benefit cognition, though there are opposing findings, reporting an apparent decrement in cognitive function, no effect, or an apparent improvement after revascularization. A great number of studies are trying to evaluate the effect of carotid revascularization (CEA, CAS) on patients' cognitive functions, as well as on their psychological condition and quality of life through a baseline and follow-up neuropsychological examination. Recent reviews refer only to the narrow limits of cognitive deficits that may be attributed to carotid stenosis, rather than elucidating the outfit of all aspects of mental and cognitive correlations. Most of those findings depict controversy in current literature as far as the neuropsychological effects of carotid revascularization techniques are concerned, while clinical entities of "vascular dementia" and "vascular depression", as well as intercurrent vascular risk factors are also addressed. This might be taken into consideration, when determining the optimal therapeutic strategy for tackling carotid artery occlusive disease, while best practice clinical decisions should be still focused on stroke prevention and symptoms alleviation, until further research on the field of neuroangiology presents undisputable conclusions regarding the underlying effects of revascularization on mood and cognition. Τhe neurovascular interface, as far as mental and neurocognitive impact of carotid stenosis is concerned, also, comprises, the conceptual pathophysiological entity of "atheroinflammation", underscoring the association of vascular lesions with cognitive impairment, major depressive disorder and bipolar disorder. Chronic recurrent ischemia and chronic low perfusion are also addressed from neurocognitive aspect, regarding therapeutic strategies that might be preferred so as to reduce the burden of chronic cerebrovascular disease in both symptomatic and asymptomatic patients, given the fact that inflammatory processes of vascular complexion underlie both neuroinflammation and atherosclerosis, affecting cerebral perfusion as well as cortical blood flow.

[颈动脉疾病与精神和神经认知障碍的关系]。
颈动脉狭窄是一种常见的血管疾病,严重影响脑血流量,因此与患者的认知功能有关。颈动脉血运重建技术(颈动脉内膜剥脱术(CEA)和颈动脉支架植入术(CAS))可能对认知功能有益,但也有相反的研究结果,有的报告说认知功能明显下降,有的报告说没有影响,有的报告说血运重建后认知功能明显改善。大量研究试图通过基线和随访神经心理学检查,评估颈动脉血运重建(CEA、CAS)对患者认知功能以及心理状况和生活质量的影响。近期的综述只提到了颈动脉狭窄可能导致的认知功能障碍的狭义范围,而没有阐明精神和认知相关性的所有方面。就颈动脉血管再通技术对神经心理学的影响而言,大多数研究结果在目前的文献中都存在争议,而 "血管性痴呆 "和 "血管性抑郁 "的临床实体以及并发的血管风险因素也被提及。在神经血管学领域的进一步研究就血管再通对情绪和认知的潜在影响得出无可争议的结论之前,最佳临床决策仍应侧重于预防中风和缓解症状。就颈动脉狭窄对精神和神经认知的影响而言,神经血管界面还包括 "动脉粥样硬化性炎症 "这一概念性病理生理学实体,强调了血管病变与认知障碍、重度抑郁症和躁狂症的关联。鉴于血管炎症过程是神经炎症和动脉粥样硬化的基础,会影响脑灌注和大脑皮层血流,因此还从神经认知方面探讨了慢性反复缺血和慢性低灌注的治疗策略,以便减轻有症状和无症状患者的慢性脑血管疾病负担。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Psychiatrike = Psychiatriki
Psychiatrike = Psychiatriki Medicine-Medicine (all)
CiteScore
2.60
自引率
0.00%
发文量
37
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