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首页> 外文期刊>Journal of Cerebral Blood Flow and Metabolism: Official Journal of the International Society of Cerebral Blood Flow and Metabolism >Thresholds of impaired cerebral hemodynamics that predict short-term cognitive decline in asymptomatic carotid stenosis
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Thresholds of impaired cerebral hemodynamics that predict short-term cognitive decline in asymptomatic carotid stenosis

机译：预测无症状性颈动脉狭窄的短期认知功能下降的脑血流动力学障碍的阈值

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摘要

Subjects with asymptomatic carotid stenosis (ACS) may be at risk of cognitive impairment due to cerebral hypoperfusion. In this study, we aimed to detect a threshold of cerebral hemodynamics which is able to identify subjects at risk of cognitive deterioration. In subjects with ACS, cerebral vasomotor reactivity (CVR) was assessed with the breath-holding index (BHI) transcranial Doppler-based method. Cognitive deterioration was defined as a decrease in the MMSE score by 2 points after one year. In order to define the threshold of impaired BHI, a ROC curve analysis was performed adopting the binary difference of MMSE score as the outcome and continuous BHI as the testing variable. A total of 548 subjects completed the follow-up. Cognitive deterioration was observed in 119 patients (21.7%). The BHI value ipsilateral to the stenosis was the strongest predictor of cognitive deterioration among the variables tested. The best cut-point to discriminate between normal and abnormal BHI resulted 0.89. The post-test probability of cognitive deterioration for an abnormal BHI was 44%, while a normal BHI showed a post-test probability of 9% for the same outcome. The present investigation provides a threshold of reduced CVR that can be useful to identify subjects with ACS at risk of cognitive deterioration.
机译：无症状性颈动脉狭窄（ACS）的受试者可能由于脑灌注不足而存在认知障碍的风险。在这项研究中，我们旨在检测脑血流动力学的阈值，该阈值能够识别处于认知退化风险的受试者。在患有ACS的受试者中，采用基于屏气多普勒的屏气指数（BHI）评估了脑血管舒缩反应（CVR）。认知能力下降定义为MMSE分数在一年后下降2分。为了定义BHI受损的阈值，采用MMSE分数的二元差作为结果，并以连续BHI作为测试变量进行了ROC曲线分析。共有548位受试者完成了随访。 119名患者（21.7％）观察到认知能力下降。在狭窄的同侧的BHI值是测试变量中认知能力下降的最强预测因子。区分正常和异常BHI的最佳切点为0.89。异常BHI的认知能力下降的测试后概率为44％，而正常BHI对相同结局的测试后概率为9％。本研究提供了降低CVR的阈值，可用于识别患有认知能力减退风险的ACS患者。

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