Carotid Atherosclerotic Calcification Characteristics Relate to Post-stroke Cognitive Impairment

Yingzhe Wang; Chanchan Li; Mengyuan Ding; Luyi Lin; Peixi Li; Yizhe Wang; Qiang Dong; Yanmei Yang; Mei Cui

doi:10.3389/fnagi.2021.682908

Carotid Atherosclerotic Calcification Characteristics Relate to Post-stroke Cognitive Impairment

Front Aging Neurosci. 2021 May 25:13:682908. doi: 10.3389/fnagi.2021.682908. eCollection 2021.

Authors

Yingzhe Wang¹, Chanchan Li², Mengyuan Ding¹, Luyi Lin², Peixi Li¹, Yizhe Wang³, Qiang Dong^{1

4}, Yanmei Yang², Mei Cui^{1

4}

Affiliations

¹ Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
² Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
³ Department of Medicine, Nanchang University, Nanchang, China.
⁴ The State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.

Abstract

Background: Together with cerebral small vessel disease (CSVD), large vessel atherosclerosis is considered to be an equally important risk factor in the progression of vascular cognitive impairment. This article aims to investigate whether carotid atherosclerotic calcification is associated with the increased risk of post-stroke cognitive impairment (PSCI). Methods: A total of 128 patients (mean age: 62.1 ± 12.2 years, 37 women) suffering from ischemic stroke underwent brain/neck computer tomography angiography examination. The presence and characteristic of carotid calcification (size, number and location) were analyzed on computer tomography angiography. White matter hyperintensity (WMH) was assessed using Fazekas scales. PSCI was diagnosed based on a battery of neuropsychological assessments implemented 6-12 months after stroke. Results: Among 128 patients, 26 developed post-stroke dementia and 96 had carotid calcification. Logistic regression found carotid calcification (odds ratio [OR] = 7.15, 95% confidence interval [CI]: 1.07-47.69) and carotid artery stenosis (OR = 6.42, 95% CI: 1.03-40.15) both significantly increased the risk for post-stroke dementia. Moreover, multiple, thick/mixed, and surface calcifications exhibited an increasing trend in PSCI (P _trend = 0.004, 0.016, 0.045, respectively). The prediction model for post-stroke dementia including carotid calcification (area under curve = 0.67), WMH (area under curve = 0.67) and other covariates yielded an area under curve (AUC) of 0.90 (95% CI: 0.82-0.99). Conclusion: Our findings demonstrated that the quantity and location of carotid calcifications were independent indicators for PSCI. The significant role of large vessel atherosclerosis in PSCI should be concerned in future study.

Keywords: Computed Tomographic Angiography; atherosclerosis; calcification; cognition; stroke.