الفهرس 
tracranial Atherosclerotic Disease and Cognitive ImpairmentOnly 14 pages are availabe for public view
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Abstract
Cerebrovascular diseases have been increasingly implicated as a cause and contributor to cognitive impairment and dementia with a strong association reported between infarcts and white matter hyperintensities (WMH) with cognitive decline. In this context, ECS and ICS have gained increasing attention due to their role in causing ischemic damage and hence cognitive dysfunction.
We prospectively included 30 patients with, either symptomatic (past history of mild ischemic stroke) or asymptomatic who were admitted to Ain Shams University Hospital as well as 15 healthy individuals matched in age and sex.
All the patients were subjected to full clinical history and examination, routine labs (including complete blood picture, liver and kidney function tests, lipid profile and HBA1c), neuroimaging (including carotid duplex, MRI brain and MRA and CT angiography over cerebral and neck vessels), neuropsychological assessment (including MMSE, WCST and WMST) and P300 analysis(latency, amplitude, reaction time and accuracy) which were done at baseline and 3 months after revascularization procedure.
And the results were as follows:
• Diabetes mellitus and hypertension were the most prevalent risk factor for extracranial or intracranial atherosclerotic disease.
• Both groups showed low scores in all scales (in comparison to the normal cut off values, which are listed in the appendix); for example, in MMSE, the mean score for MMSE in IC stenosis group was 24.9 ± 3.7, consistent with mild cognitive impairment, and 23.1 ± 2.6 for EC stenosis group, consistent with dementia.
• The most notable finding is that although both groups were suffered cognitive impairment, yet the EC stenosis group showed much more decline in their cognitive functions in comparison to the IC stenosis group, especially in the mental control category (p-value 0.033) and in digit span total score (p-value 0.037).
• P300 results showed that there is statistically significant difference between cases (both IC and EC stenosis groups) and controls as regard the latency, accuracy and reaction time, which measure attention and processing speed, making p300 an objective tool that can be used to detect cognitive impairment in those patients.
• Both case groups showed improvement in their cognitive function 3 months after the revascularization procedure with significant improvement in all cognitive scales:
a) In MMSE, they showed significant improvement (p-value<0.001), reflecting global improvement in their cognitive function.
b) In WMST, they showed significant improvement (p-value <0.001) in mental control, logical memory and digit span, reflecting improvement in working, verbal, visual memory and attention.
c) In WCST, they showed significant improvement in categories completed and perseverative errors, reflecting improvement in their prefrontal executive function.
d) In P300, an objective test, both groups showed marked improvement in latency, accuracy and reaction time, reflecting improvement in attention and processing speed.
e) Finally, the EC stenosis group showed more improvement in comparison to IC stenosis group in MMSE total scores, all WMST categories and all P30w2w0 parameters.