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. 2021 Jan 30:2:100004.
doi: 10.1016/j.cccb.2021.100004. eCollection 2021.

Measurement of carotid plaque burden: A tool for predicting and preventing dementia?

John J Shin  1 , Vladimir Hachinski  2 , M Reza Azarpazhooh  2   3 , Aidin Shariatzadeh  3 , J David Spence  2   3
Affiliations

Measurement of carotid plaque burden: A tool for predicting and preventing dementia?

John J Shin et al. Cereb Circ Cogn Behav. .

Abstract

Introduction: Carotid plaque burden is a strong predictor of stroke risk, and preventing stroke reduces the risk of dementia. Treating carotid plaque burden markedly reduces the risk of stroke.

Methods: Among patients age 65-80 years attending a stroke prevention clinic, we identified those with a carotid plaque burden in the top 20% of Total Plaque Area (High TPA) and the bottom 20% (Low TPA) and performed cognitive tests: The Montreal Cognitive Assessment test (MoCA), the WAIS-III Digit Symbol-Coding Test (DSST) and Trail-Making Test (TMT) part A and B.

Results: There were 31 patients recruited; 11 Low TPA (5 men) and 20 High TPA (17 men), p = 0.04. TPA was 35 ± 25 mm2 in the Low TPA vs.392 ± 169 mm2 in the High TPA group (0.0001). Patients with a high plaque burden had significantly worse performance on all the cognitive tests, all p< 0.05.

Discussion: A high carotid plaque burden identifies patients at risk of cognitive impairment. Because carotid plaque burden is treatable, and treating it markedly reduces the risk of stroke, we suggest that measurement of plaque burden is a useful tool for both prediction of cognitive impairment, and prevention of dementia.

Keywords: ADAS, Alzheimer's Disease Assessment Scale; ANOVA, Analysis of variance; Atherosclerosis; Carotid plaque burden; Cognition; DSST, WAIS-III Digit Symbol-Coding Test; Dementia; MMSE, Mini mental state examination; MOCA, Montreal Cognitive Assessment test; Prediction; Prevention; SPARC, Stroke Prevention & Atherosclerosis Research Centre; TMT, Trail-Making Test; TPA, Carotid Total Plaque Area.

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Conflict of interest statement

JS, MRA, AS and VH have no interests to declare. JDS is a consultant to Amgen and Orphan Technologies, and an unpaid officer of Vascularis Inc.

Figures

Fig. 1
Fig. 1
Examples of patients with high vs. low carotid total plaque area (TPA) These are composite drawings of plaques in the carotid arteries, from ultrasound reports. The black areas represent plaques in the wall of the artery; the numbers in the lumen represent peak velocity in cm/s. a. A 79-year old woman with 471 mm2 of plaque; 9 times normal for age and sex. b. A 72-year old man with only 6 mm2 of plaque; normal for age and sex would be 40 mm2. (Reproduced by permission of Karger Publishers from: Bogiatzi C, Wannarong T, McLeod AI, Heisel M, Hackam D, Spence JD. SPARKLE (Subtypes of Ischaemic Stroke Classification System), incorporating measurement of carotid plaque burden: a new validated tool for the classification of ischemic stroke subtypes. Neuroepidemiology. 2014;42(4):243–51.
Fig. 2
Fig. 2
Cognitive function was significantly better with low plaque burden (Low TPA) than with high plaque burden (High TPA). A. Montreal Cognitive Assessment; MoCA; B. WAIS-III Digit Symbol-Coding Test, DSST; C. Trail making A and B test scores for the Low TPA and High TPA groups; D. A composite score combining all three tests. All p<0.05, ANOVA.
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