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Abstract
Objective To investigate the association between intracranial atherosclerosis (ICAS) and cognitive functioning in patients with a history of vascular disease.
Methods Within the Second Manifestations of Arterial Disease–Magnetic Resonance (SMART-MR) study, cross-sectional analyses were performed in 130 patients (mean ± SD age 68 ± 9 years) with 7T vessel wall MRI data. Vessel wall lesions were rated according to established criteria and summed into a circulatory and artery-specific ICAS burden. Associations between ICAS burden and Z scores of memory, executive functioning, working memory, and processing speed were estimated using linear regression analyses adjusted for age, sex, education, reading ability, and vascular risk factors.
Results A total of 125 patients (96%) had ≥1 vessel wall lesion; the mean ICAS burden was 8.5 ± 5.7. A statistically nonsignificant association was found between total ICAS burden and memory (b = −0.03 per +1 lesion; 95% confidence interval [CI] −0.05 to 0.00). No associations were found for the other domains. A statistically significant association was found for ICAS burden of the posterior cerebral artery (PCA) and memory (b = −0.12 per +1 lesion; 95% CI −0.23 to −0.01) and executive functioning (b = −0.10 per +1 lesion; 95% CI −0.19 to −0.01). Statistically nonsignificant associations were found for the anterior cerebral artery (ACA) burden and memory (b = −0.13 per +1 lesion; 95% CI −0.26 to 0.01) and executive functioning (b = −0.11 per +1 lesion; 95% CI −0.22 to 0.01). Additional adjustments for large infarcts, white matter hyperintensities, lacunes, and ≥50% carotid stenosis produced similar results.
Conclusions Our results suggest an artery-specific vulnerability of memory and executive functioning to ICAS, possibly due to strategic brain regions involved with these cognitive domains, which are located in the arterial territory of the PCA and ACA.
Glossary
- ACA=
- anterior cerebral artery;
- AD=
- Alzheimer disease;
- ARIC=
- Atherosclerosis Risk in Communities;
- BMI=
- body mass index;
- CI=
- confidence interval;
- CSVD=
- cerebral small vessel disease;
- DBP=
- diastolic blood pressure;
- FLAIR=
- fluid-attenuated inversion recovery;
- FOV=
- field of view;
- HDL=
- high-density lipoprotein;
- ICA=
- internal carotid artery;
- ICAS=
- intracranial atherosclerosis;
- ICASAC=
- intracranial atherosclerosis burden for the anterior circulation;
- ICASACA=
- intracranial atherosclerosis burden for the anterior cerebral artery;
- ICASPC=
- intracranial atherosclerosis burden for the posterior circulation;
- ICASPCA=
- intracranial atherosclerosis burden for the posterior cerebral artery;
- ICASTC=
- intracranial atherosclerosis burden for the total cerebral circulation;
- MCA=
- middle cerebral artery;
- MCI=
- mild cognitive impairment;
- MMSE=
- Mini-Mental State Examination;
- MRA=
- magnetic resonance angiography;
- PCA=
- posterior cerebral artery;
- SBP=
- systolic blood pressure;
- SMART-MR=
- Second Manifestations of Arterial Disease–Magnetic Resonance;
- SWI=
- susceptibility-weighted imaging;
- TE=
- echo time;
- TI=
- inversion time;
- TR=
- repetition time;
- WMH=
- white matter hyperintensity
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
UCC-SMART Study Group coinvestigators are listed in appendix 2 at the end of the article.
- Received March 4, 2019.
- Accepted in final form March 11, 2020.
- © 2020 American Academy of Neurology
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